NPI 1023793932

Michael Charles Lick

Practitioner Physician Assistant Bloomington, MN

Practice location

Address: 4300 Market Pte Dr STE 100, Bloomington, MN 55435-5435
Phone: (457) 495-2767
Mailing address: 115 W 5th St # 2, Duluth, MN 55806-2729

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X

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Registry record

NPI: 1023793932
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Jun 2023
Record last updated: 13 Jan 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.