Facts
- Status
- A
- Credential
- P.A.
- Type
- Individual
- Enumeration date
- 2007-01-09
- Last updated
- 2007-08-28
Specialties
Licenses
- License MN
- 9545
Location
- Practice location
- CENTRAL MINNESOTA EMERGENCY PHYSICIANS, 1406 6TH AVENUE NORTH
- City
- ST CLOUD MN
- Postal code
- 563031901
- Phone
- 320-255-5656
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.