KURTIS A. WATERS, M.D., P.A. (NPI# 1265583652) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265583652 |
| Entity Type | Organization |
| Organization Name | KURTIS A. WATERS, M.D., P.A. |
| Practice Address |
13359 Isle Dr Suite 1 Baxter MN 56425-2221 |
| Practice Telephone | 2184548888 |
| Mailing Telephone | 2184548888 |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-04-27 |
| Authorized Official Name | DR. KURTIS ALLEN WATERS (DIRECTOR) |
| Authorized Official Telephone | 2188287157 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
37843 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 930218200 | 05 | |
| MN | BLUE CROSS BLUE SHIELD MN | 422K7WA | 01 |
| Street Address |
13359 ISLE DR SUITE 1 |
| City | BAXTER |
| State | MN |
| Zip Code | 56425-2221 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699759647 | Paul Lundstrom | Dermatology | 13359 Isle Dr, Suite 3, Baxter, MN 56425-2222 | 2005-12-02 |
| 1720269426 | Dermatology Professionals, Pa | Clinic/Center | 13359 Isle Dr, Ste 3, Baxter, MN 56425 | 2007-11-21 |
| 1821180712 | Nicole Therese Manecke | Physician Assistant | 13359 Isle Dr, Suite 3, Baxter, MN 56425-2222 | 2006-09-28 |
| 1568440717 | Kurtis Allen Waters | Otolaryngology | 13359 Isle Dr, Suite 1, Baxter, MN 56425-2221 | 2006-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396364089 | Jennifer Ann Olson | Behavioral Analyst | Autism Matters 14387 Edgewood Drive, Baxter, MN 56425 | 2020-04-13 |
| 1801229000 | Longville Lakes Clinic, Inc. | Clinic/Center | 13205 Isle Drive, Baxter, MN 56425 | 2013-08-12 |
| 1033555867 | Shiela Klemmetsen | Family Medicine | Essentia Health St. Joseph's-baxter Clinic, 13060 Isle Drive, Baxter, MN 56425 | 2013-05-20 |
| 1053547299 | Linda Marie Bowman | Social Worker | 13397 Shadow Wood Drive, Baxter, MN 56425 | 2009-06-02 |
| 1215112792 | Brainerd Medical Center, Inc. | Nurse Practitioner | 14133 Edgewood Drive, Baxter, MN 56425 | 2008-01-03 |
| 1134313208 | Sleep Center of Central Minnesota LLC | Clinic/Center | 13495 Elder Drive, Suite 120, Baxter, MN 56425 | 2007-08-31 |
| 1750582482 | Jacqueline Elizabeth Oelfke | Nurse Practitioner | Cbhh-baxter, 14241 Grand Oaks Dr., Baxter, MN 56425 | 2007-05-30 |
| 1508080631 | Five Star Living of Brainerd, LLC | Assisted Living Facility | 14398 Grand Oaks Drive, Baxter, MN 56425 | 2007-04-12 |
| 1093842247 | Five Star Living of Brainerd, LLC | Assisted Living Facility | 14396 Grand Oaks Dr, Baxter, MN 56425 | 2007-02-27 |
| 1053458364 | Teri Kaminski Peterson | Speech-Language Pathologist | 15620 Edgewood Dr Ste 240, Baxter, MN 56425 | 2007-01-30 |
| Find all providers in zip 56425 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427493485 | Ronald J Schroeder II | Otolaryngology | 2080 Woodwinds Dr Ste 220, Woodbury, MN 55125-2529 | 2013-05-05 |
| 1851518674 | Edward Henry Szachowicz | Otolaryngology | 7373 France Av. So., Suite #508, Edina, MN 55435-4549 | 2007-04-20 |
| 1306842711 | Rick Lee Nissen | Otolaryngology | 8714 Lyndale Ave S, Minneapolis, MN 55420-2738 | 2005-06-22 |
| 1669897500 | Casey Fisher | Otolaryngology | 3366 Oakdale Ave N Ste 150, Robbinsdale, MN 55422-2978 | 2014-03-02 |
| 1316212632 | Brett James Baldwin | Otolaryngology | 1421 Premier Dr, Mankato, MN 56001-6076 | 2012-03-20 |
| 1891089850 | Nathan Daniel Johnson | Otolaryngology | 2211 Park Ave, Minneapolis, MN 55404-3711 | 2011-06-07 |
| 1043256357 | Christopher John Tolan | Otolaryngology | 2080 Woodwinds Drive, #240, Woodbury, MN 55125 | 2006-06-22 |
| 1194775429 | Michael D Peters | Otolaryngology | 9825 Hospital Dr, Suite Ll-10, Maple Grove, MN 55369-4479 | 2006-05-10 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.