Individual
DR. KATHLEEN MACCARTHY DEMANIVEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4478
(763) 898-1000
Mailing address
14500 99TH AVE N, MAPLE GROVE, MN 55369-4478
(763) 898-1000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
31117
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
550507100
—
MN
Enumeration date
10/25/2005
Last updated
08/13/2012
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