Healthcare Provider Details

I. General information

NPI: 1891770459
Provider Name (Legal Business Name): KRISTIN MARIE KIRSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 18TH AVE NW
ROCHESTER MN
55901
US

IV. Provider business mailing address

2222 18TH AVE NW
ROCHESTER MN
55901-7724
US

V. Phone/Fax

Practice location:
  • Phone: 651-287-0185
  • Fax: 507-258-4020
Mailing address:
  • Phone: 651-287-0185
  • Fax: 507-258-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number46019
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46019
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46019
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: