Provider Demographics
NPI:1770717795
Name:LUSIAN SALINE, KRISTIN JO (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JO
Last Name:LUSIAN SALINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 SNOWY OWL CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1189
Mailing Address - Country:US
Mailing Address - Phone:218-428-7355
Mailing Address - Fax:
Practice Address - Street 1:4212 GRAND AVE
Practice Address - Street 2:ESSENTIA HEALTH WEST DULUTH CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2737
Practice Address - Country:US
Practice Address - Phone:218-786-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57448207Q00000X
MN53083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-42322OtherMEDICA
P00860773OtherRR MEDICARE
1770717795OtherBCBS
MN1770717795Medicaid
1770717795OtherBCBS