Provider Demographics
NPI:1497739247
Name:MAUCIERI, KARA LEE (MD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LEE
Last Name:MAUCIERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:LEE
Other - Last Name:DAHLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1645
Mailing Address - Country:US
Mailing Address - Phone:218-546-7000
Mailing Address - Fax:218-545-4456
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1645
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-545-4456
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080006801OtherMEDICARE
NS1141016489OtherPREFERRED ONE
0116180OtherMEDICA
112865C750OtherUCARE
50Q23MAOtherBCBS
7884035OtherAETNA
779799OtherAMERICAS PPO
E007OtherTRICARE
MN246823900Medicaid
080122966OtherRR MEDICARE
HP26005OtherHEALTHPARTNERS
HP26005OtherHEALTHPARTNERS
0116180OtherMEDICA