NPI 1568773679

Charles Glen Mickelson, CPED

Practitioner Pedorthist South St. Paul,, MN

Practice location

Address: 423 12th Ave. North, South St. Paul,, MN 55075-1915
Phone: (651) 291-7000

Registered specialties

Pedorthist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224L00000X

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Registry record

NPI: 1568773679
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Jun 2010
Record last updated: 9 Nov 2010

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.