Healthcare Provider Details

I. General information

NPI: 1831149046
Provider Name (Legal Business Name): KATHLEEN SULENTICH M.D./F.A.C.O.G.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 1ST ST S SUITE 112
VIRGINIA MN
55792-2696
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-741-6221
  • Fax: 218-741-2550
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19781
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: