Provider Demographics
NPI:1487674040
Name:HARTING, KERRI LYN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:LYN
Last Name:HARTING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KERRI
Other - Middle Name:LYN
Other - Last Name:DIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 CAMPUS DR STE 10
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-8812
Mailing Address - Country:US
Mailing Address - Phone:763-398-4400
Mailing Address - Fax:
Practice Address - Street 1:2800 CAMPUS DR STE 20
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-2669
Practice Address - Country:US
Practice Address - Phone:763-398-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN607632085R0202X, 2085R0202X
IL036-1125852085R0202X
KS04-335982085R0202X
MI43010869332085R0202X
WI45673-202085R0202X
IAMD-437862085R0202X
NE295802085R0202X
NDPT143102085R0202X
SD100432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201223401Medicaid
MO201223401Medicaid
MO961110769Medicare PIN