Provider Demographics
NPI:1114942372
Name:WOOD, KATHLEEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:WOOD
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 1:705 13TH AVE N
Mailing Address - Street 2:APT. 310
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2680
Mailing Address - Country:US
Mailing Address - Phone:218-779-0533
Mailing Address - Fax:
Practice Address - Street 1:705 13TH AVE N
Practice Address - Street 2:APT. 310
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2680
Practice Address - Country:US
Practice Address - Phone:218-779-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4980208D00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice