Provider Demographics
NPI:1043576853
Name:LARSON, KATIE ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N HARMON DR
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-6242
Mailing Address - Country:US
Mailing Address - Phone:605-670-9305
Mailing Address - Fax:605-996-3385
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-7800
Practice Address - Fax:605-328-7899
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics