Provider Demographics
NPI:1487900577
Name:BLIXT, ELIZABETH KATE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KATE
Last Name:BLIXT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE 2575
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4924
Mailing Address - Fax:320-229-4971
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 2575
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4924
Practice Address - Fax:320-229-4971
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56812207N00000X
MN107024207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01238261OtherRAILROAD MEDICARE
MNP01238261OtherRAILROAD MEDICARE