Provider Demographics
NPI:1528138450
Name:WATSON, KATHLEEN V (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:V
Last Name:WATSON
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:UNIVERISITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 741
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-884-0999
Mailing Address - Fax:
Practice Address - Street 1:UNIVERISITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, CLINIC 3A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25764207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN737872600Medicaid
1000062OtherPREFERREDONE
0402803OtherMEDICA - PRIMARY
0402804OtherMEDICA - CHOICE
768402OtherARAZ
101529OtherUCARE
2T190WAOtherBLUE CROSS BLUE SHIELD
HP22152OtherHEALTHPARTNERS
IA0500611Medicaid
1000062OtherPREFERREDONE
101529OtherUCARE
830000030Medicare ID - Type Unspecified