MEDICARE: DR. KRISTIN KAY ELLIOTT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	37113	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080163118	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609867753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN KAY ELLIOTT MD

Provider Business Mailing Address
First Line	:	320 E MAIN ST
Second Line	:
City	:	CROSBY
State	:	MN
Zip	:	56441-1645
Country	:	US
Telephone Number	:	218-546-8375
Fax Number	:	218-546-4400

Provider Business Practice Location Address
First Line	:	320 E MAIN ST
Second Line	:
City	:	CROSBY
State	:	MN
Zip	:	56441-1645
Country	:	US
Telephone Number	:	218-546-8375
Fax Number	:	218-546-4400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	10/03/2012

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