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General NPI Number Information
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NPI Number | 1043379571
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Entity Type | Organization
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Legal Business Name | KATHRYN LYNN FISCHER, MD, LLC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 574 PRAIRIE CENTER DR #135-292
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7930
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Country | US
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Telephone | 612-710-3671
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Fax | 763-295-4946
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Provider Business Mailing Address
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Address Line | 574 PRAIRIE CENTER DR #135-292
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7930
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Country | US
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Telephone | 612-710-3671
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Fax | 763-295-4946
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | KATHRYN LYNN FISCHER
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Credential | M.D.
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Telephone | 612-710-3671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 47326
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License Number State | MN
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