Healthcare Provider Details

I. General information

NPI: 1346986601
Provider Name (Legal Business Name): KAITLYN ANDERHOLM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 2ND ST SW
WILLMAR MN
56201-3337
US

IV. Provider business mailing address

502 2ND ST SW
WILLMAR MN
56201-3337
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-7232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number83288
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: