Provider Demographics
NPI:1669453726
Name:RIORDAN, KATHRYN K (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:K
Last Name:RIORDAN
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 1:49725 COUNTY 83
Mailing Address - Street 2:
Mailing Address - City:STAPLES
Mailing Address - State:MN
Mailing Address - Zip Code:56479-5280
Mailing Address - Country:US
Mailing Address - Phone:218-894-1515
Mailing Address - Fax:218-894-8767
Practice Address - Street 1:49725 COUNTY 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479-5280
Practice Address - Country:US
Practice Address - Phone:218-894-1515
Practice Address - Fax:218-894-8767
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39593207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114076OtherFIRST HEALTH PLAN
600935OtherARAZ GROUP AMERICAS PPO
114224100OtherMEDICAL ASSISTANCE
33A94RIOtherBLUE CROSS BLUE SHIELD
101727OtherUCARE
3211049OtherMEDICA HEALTH PLANS
1012375OtherPREFERRED ONE
HP25255OtherHEALTH PARTNERS
1012375OtherPREFERRED ONE
2114076OtherFIRST HEALTH PLAN
660000096Medicare ID - Type Unspecified