Provider Demographics
NPI:1598285348
Name:HELLIE, KAITLIN J (MD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:J
Last Name:HELLIE
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 1:6200 SHINGLE CREEK PKWY STE 260
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2128
Mailing Address - Country:US
Mailing Address - Phone:763-544-0696
Mailing Address - Fax:612-262-9035
Practice Address - Street 1:6200 SHINGLE CREEK PKWY STE 260
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2128
Practice Address - Country:US
Practice Address - Phone:763-544-0696
Practice Address - Fax:763-544-0984
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN64534390200000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program