Provider Demographics
NPI:1114979390
Name:CASE, KRISTEN CARUSO (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CARUSO
Last Name:CASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8800
Mailing Address - Fax:
Practice Address - Street 1:6363 FRANCE AVE S STE 200
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2140
Practice Address - Country:US
Practice Address - Phone:952-230-9100
Practice Address - Fax:952-922-2525
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN482552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP62326OtherHEALTHPARTNERS
WI34846100Medicaid