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General NPI Number Information
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NPI Number | 1356635007
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Entity Type | Individual
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Provider Name | KATHRYN GILLEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/30/2011
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 401 PHALEN BLVD
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City | SAINT PAUL
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State | MN
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Zip | 55130-5302
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Country | US
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Telephone | 651-254-7670
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Fax | 651-254-7676
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # MS 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56059
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 56059
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 05-37991
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 56059
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License Number State | MN
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