Healthcare Provider Details

I. General information

NPI: 1881798585
Provider Name (Legal Business Name): KATHLEEN SULENTICH MD FACOG LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 04/18/2008
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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN SULENTICH
Title or Position: OWNER
Credential: MD
Phone: 218-741-6221