Provider Demographics
NPI:1013953488
Name:FLORY, KATHRYN G (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:FLORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9825 HOSPITAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4768
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-494-7501
Practice Address - Street 1:9825 HOSPITAL DR STE 300
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-494-7501
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN32860207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN762502200Medicaid
MN160000474Medicare PIN
MN762502200Medicaid