Provider Demographics
NPI:1154002244
Name:MAROTZKE-KUNZE, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MAROTZKE-KUNZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-2437
Mailing Address - Country:US
Mailing Address - Phone:507-360-2638
Mailing Address - Fax:
Practice Address - Street 1:1227 3RD AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2437
Practice Address - Country:US
Practice Address - Phone:507-360-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service