Basic Information
| Provider Information | |||||||||
| NPI: | 1386960250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENTZ | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | JANE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2925 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554071321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122625000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1155 COUNTY ROAD E E STE 100 | ||||||||
| Address2: | |||||||||
| City: | VADNAIS HEIGHTS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551105191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512419200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 54835 | MN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 54835 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.