Provider Demographics
NPI:1205841715
Name:KAULS, LYNDA SUE (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:SUE
Last Name:KAULS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 MARKET ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1627
Mailing Address - Country:US
Mailing Address - Phone:612-746-4144
Mailing Address - Fax:612-746-4149
Practice Address - Street 1:275 MARKET ST
Practice Address - Street 2:SUITE 215
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1627
Practice Address - Country:US
Practice Address - Phone:612-746-4144
Practice Address - Fax:612-746-4149
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN50023207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN423680000Medicaid
MN423680000Medicaid