Provider Demographics
NPI:1114978335
Name:FARNIOK, KATHRYN E (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:E
Last Name:FARNIOK
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 1:345 SHERMAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2401
Mailing Address - Country:US
Mailing Address - Phone:651-251-5500
Mailing Address - Fax:651-251-5555
Practice Address - Street 1:345 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2401
Practice Address - Country:US
Practice Address - Phone:651-251-5500
Practice Address - Fax:651-251-5555
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2400212OtherMEDICA
MN084708900Medicaid
MN1009102OtherPREFERRED ONE
WI31650500Medicaid
MN2400212OtherMEDICA