Provider Demographics
NPI:1114982170
Name:LOCKHART, KRISTIN R (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1687 WOODLANE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3046
Mailing Address - Country:US
Mailing Address - Phone:651-600-3035
Mailing Address - Fax:651-326-5350
Practice Address - Street 1:1099 HELMO AVE N
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6033
Practice Address - Country:US
Practice Address - Phone:651-326-5300
Practice Address - Fax:651-326-5350
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-01-10
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Provider Licenses
StateLicense IDTaxonomies
MN45037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH72895Medicare UPIN