Provider Demographics
NPI:1326281056
Name:KUZMENKO, YEKATERINA ALEKSANDROVNA (MD)
Entity Type:Individual
Prefix:
First Name:YEKATERINA
Middle Name:ALEKSANDROVNA
Last Name:KUZMENKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 SLOAN PL STE 17
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2051
Mailing Address - Country:US
Mailing Address - Phone:651-772-6251
Mailing Address - Fax:651-224-9661
Practice Address - Street 1:1997 SLOAN PL STE 17
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55117-2051
Practice Address - Country:US
Practice Address - Phone:651-772-6251
Practice Address - Fax:651-224-9661
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57596207R00000X, 207R00000X
MN66495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
68375Medicare PIN