Provider Demographics
NPI:1992750806
Name:KIVI, STEPHANIE A (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:KIVI
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Gender:F
Credentials:MD
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Mailing Address - Street 1:301 2ND ST NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-1709
Mailing Address - Country:US
Mailing Address - Phone:952-758-4431
Mailing Address - Fax:952-758-5011
Practice Address - Street 1:202 1ST ST S
Practice Address - Street 2:MONTGOMERY MEDICAL
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1602
Practice Address - Country:US
Practice Address - Phone:507-364-5600
Practice Address - Fax:507-364-5686
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-01-11
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Provider Licenses
StateLicense IDTaxonomies
MN38537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN160017600Medicaid
MN160017600Medicaid
MNG36530Medicare UPIN