MEDICARE: KATHERINE GRACE ESSE 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	207R00000X	Internal Medicine Physician	58332	MN
2	2084N0400X	Neurology Physician	58332	MN

General Provider Information

NPI Number	:	1720255367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE GRACE ESSE MD

Provider Business Mailing Address
First Line	:	2925 CHICAGO AVE
Second Line	:	MAIL ROUTE 10202
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-262-1166
Fax Number	:	612-262-4258

Provider Business Practice Location Address
First Line	:	255 SMITH AVE N
Second Line	:	SUITE 500
City	:	ST. PAUL
State	:	MN
Zip	:	55102-2545
Country	:	US
Telephone Number	:	651-241-6550
Fax Number	:	651-241-6586

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	11/10/2020

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