Provider Demographics
NPI:1528099538
Name:WERDIN, KRISTI LEE (MD)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEE
Last Name:WERDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HAZELWOOD ST STE 310
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1241
Mailing Address - Country:US
Mailing Address - Phone:651-264-1500
Mailing Address - Fax:651-264-1646
Practice Address - Street 1:2945 HAZELWOOD ST STE 310
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1241
Practice Address - Country:US
Practice Address - Phone:651-264-1500
Practice Address - Fax:651-264-1646
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34357207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN466565100Medicaid
220000322Medicare ID - Type Unspecified
MN466565100Medicaid