Provider Demographics
NPI:1265844385
Name:LAUBE WARD, KAITLYN LEIGH (DPM)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:LEIGH
Last Name:LAUBE WARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:LEIGH
Other - Last Name:LAUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9201 W BROADWAY AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1924
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7066
Practice Address - Street 1:9825 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4768
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-494-7501
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1124213ES0103X
WAPL60565835213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery