Basic Information
| Provider Information | |||||||||
| NPI: | 1578668174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUSENBERY | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE MMC 494 | ||||||||
| Address2: | MMUNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HARVARD ST SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122736700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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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 | 207RX0202X | 29219 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 2085R0203X | 29219 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2422566 | 01 | MN | MEDICA-CHOICE | OTHER | 2T422DU | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 768091 | 01 | ARAZ | OTHER | 0051408 | 05 | MT | MEDICAID | 101256 | 01 | MN | U CARE | OTHER | HP22123 | 01 | MN | HEALTH PARTNERS | OTHER | 1010261 | 01 | MN | PREFERRED ONE | OTHER | 884508500 | 05 | MN | MEDICAID | 023705 | 01 | MN | FAIRVIEW | OTHER | 24-02006 | 01 | MN | MEDICA-PRIMARY | OTHER |