Provider Demographics
NPI:1780691576
Name:BOENTE, KATHRYN T (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:T
Last Name:BOENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:TWEEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3625 W 65TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2106
Mailing Address - Country:US
Mailing Address - Phone:952-920-7001
Mailing Address - Fax:952-345-0472
Practice Address - Street 1:395 HICKEY BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2770
Practice Address - Country:US
Practice Address - Phone:650-752-2173
Practice Address - Fax:650-301-4631
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45148207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN319800600Medicaid
MN276J0TWOtherBCBS
MN0702968OtherMEDICA
MN160003495Medicare PIN
MN276J0TWOtherBCBS