Provider Demographics
NPI:1841374030
Name:MIDGARDEN, KRISTI J (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:J
Last Name:MIDGARDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PARK ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-4103
Mailing Address - Country:US
Mailing Address - Phone:701-284-6663
Mailing Address - Fax:701-284-6923
Practice Address - Street 1:503 PARK ST W
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4103
Practice Address - Country:US
Practice Address - Phone:701-284-6663
Practice Address - Fax:701-284-6923
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND28252OtherBCBS OF ND
ND10874Medicaid
ND28252OtherBLUE CROSS BLUE SHIELD
MN924G8MIOtherBLUE CROSS BLUE SHIELD
MN926220200OtherMEDICAID
ND10874Medicaid
MN924G8MIOtherBLUE CROSS BLUE SHIELD