Healthcare Provider Details

I. General information

NPI: 1023953932
Provider Name (Legal Business Name): KAITLYN BUTZIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

2440 PARMENTER BLVD APT 211D
ROYAL OAK MI
48073-1342
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-3113
  • Fax:
Mailing address:
  • Phone: 217-372-6933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: