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General NPI Number Information
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NPI Number | 1992750806
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Entity Type | Individual
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Provider Name | STEPHANIE A KIVI MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 202 1ST ST S MONTGOMERY MEDICAL
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City | MONTGOMERY
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State | MN
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Zip | 56069-1602
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Country | US
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Telephone | 507-364-5600
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Fax | 507-364-5686
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Provider Business Mailing Address
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Address Line | 301 2ND ST NE SUITE 1
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City | NEW PRAGUE
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State | MN
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Zip | 56071-1709
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Country | US
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Telephone | 952-758-4431
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Fax | 952-758-5011
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38537
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License Number State | MN
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