Provider Demographics
NPI:1659443679
Name:KUECHENMEISTER, KIM RENAE (NA)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RENAE
Last Name:KUECHENMEISTER
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 SIXTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MADISION
Mailing Address - State:MN
Mailing Address - Zip Code:56256
Mailing Address - Country:US
Mailing Address - Phone:320-598-7566
Mailing Address - Fax:320-598-3760
Practice Address - Street 1:323 SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:MADISION
Practice Address - State:MN
Practice Address - Zip Code:56256
Practice Address - Country:US
Practice Address - Phone:320-598-7566
Practice Address - Fax:320-598-3760
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN166363100Medicaid
MN46044MAOtherBLUE PLUS MEDICAID
MN114995OtherUCARE MEDICAID
MN46044MAOtherBLUE PLUS MEDICAID