Provider Demographics
NPI:1891924718
Name:GRANDE, KATHRYN BURNS (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BURNS
Last Name:GRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:GRANDE
Other - Last Name:KREMENAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:SUITE 622
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-227-9141
Mailing Address - Fax:651-265-6772
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:SUITE 622
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-227-9141
Practice Address - Fax:651-265-6772
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56063207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology