Individual
MS. KATHERINE DIAZ VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MSC
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6852
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6852
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301100106
MI
207Q00000X
Family Medicine Physician
Primary
52548
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2008
Last updated
01/28/2014
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