Provider Demographics
NPI:1306873237
Name:HOLTMEIER, KIM DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:DIANE
Last Name:HOLTMEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 ORKLA DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3934
Mailing Address - Country:US
Mailing Address - Phone:952-564-0471
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1344
Practice Address - Country:US
Practice Address - Phone:651-769-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN493162084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35094Medicare UPIN