Basic Information
| Provider Information | |||||||||
| NPI: | 1518019389 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAJEK | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | LPN, CST, CFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6405 FRANCE AVE S STE W400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202730 | ||||||||
| FaxNumber: | 7633832134 | ||||||||
| Practice Location | |||||||||
| Address1: | 6405 FRANCE AVE S STE W400 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529202730 | ||||||||
| FaxNumber: | 7633832134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | L0214605 | MN | Y |
ID Information
| ID | Type | State | Issuer | Description | 89A15RA | 01 | MN | BCBS | OTHER |