Healthcare Provider Details

I. General information

NPI: 1487741534
Provider Name (Legal Business Name): KATIE A MORIARTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST # MS 11102M
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

8170 33RD AVE S MS21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-4887
  • Fax: 651-254-1603
Mailing address:
  • Phone:
  • Fax: 651-254-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number51409
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number51409
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: