Provider Demographics
NPI:1326272568
Name:TUMILTY, KATHARINE D (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:D
Last Name:TUMILTY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6517 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2103
Mailing Address - Country:US
Mailing Address - Phone:952-920-9191
Mailing Address - Fax:952-920-0232
Practice Address - Street 1:14050 NICOLLET AVE STE 300
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-435-2450
Practice Address - Fax:952-892-0217
Is Sole Proprietor?:No
Enumeration Date:2009-05-02
Last Update Date:2018-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN54779208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics