Healthcare Provider Details

I. General information

NPI: 1841374030
Provider Name (Legal Business Name): KRISTI J MIDGARDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 PARK ST W
PARK RIVER ND
58270-4103
US

IV. Provider business mailing address

503 PARK ST W
PARK RIVER ND
58270-4103
US

V. Phone/Fax

Practice location:
  • Phone: 701-284-6663
  • Fax: 701-284-6923
Mailing address:
  • Phone: 701-284-6663
  • Fax: 701-284-6923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8012
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: