MR. CHARLES GLEN MICKELSON (NPI# 1568773679) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568773679 |
| Entity Type | Individual |
| Full Name | MR. CHARLES GLEN MICKELSON |
| Credential | C.PED. |
| Practice Address |
423 12th Ave. North South St. Paul MN 55075-1915 |
| Practice Telephone | 6512917000 |
| Mailing Telephone | 6512917000 |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2010-11-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 224L00000X | Pedorthist | MN | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447275318 | Charles Chris Mickelson | Emergency Medicine | 250 Hospital Pl, Soldotna, AK 99669-7559 | 2006-07-13 |
| Street Address |
423 12TH AVE. NORTH |
| City | SOUTH ST. PAUL, |
| State | MN |
| Zip Code | 55075-1915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841510567 | Amber Martina Lindeman | Psychologist | 2245 Jewel Ln, South St Paul, MN 55075 | 2010-06-03 |
| 1114242690 | James G Derifield | Pharmacist | 102 5th Ave. No, So.st.paul, MN 55075 | 2010-03-29 |
| 1952546160 | Modern Dental Professionals, Minnesota PC | Dentist | 680 Southview Blvd., South Saint Paul, MN 55075 | 2008-12-03 |
| 1528272887 | Michael John Prueher | Dentist | Dental South P A, 800 Marie Avenue, South St Paul, MN 55075 | 2007-05-09 |
| 1093851651 | Keith Frank Ostrosky | Dentist | 351 15th Ave N, South St. Paul, MN 55075 | 2007-01-30 |
| 1548314792 | Health 1st Chiropractic and Wellness Center, P.C. | Chiropractor | 1020 Marie Avenue, South St. Paul, MN 55075 | 2007-01-23 |
| 1922170828 | Bridget Louise Fensholt | Dentist | 107 7th Ave South, South St Paul, MN 55075 | 2006-11-15 |
| 1558431890 | Dental South Pa | Dentist | 800 Marie Avenue, South St Paul, MN 55075 | 2006-11-08 |
| 1336494418 | Deaf Can Inc. | In Home Supportive Care | 408 Bircher Ave, South St Paul, MN 55075-1007 | 2012-07-16 |
| 1144217159 | Merrill Edward Zieman | Psychologist | 201 Concord Exchange N, South St Paul, MN 55075-1104 | 2005-10-04 |
| Find all providers in zip 55075 | ||||
| Taxonomy Code | 224L00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Pedorthist |
| An individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices. |
| Notes: Source: National Uniform Claim Committee [7/1/2010: new] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| City | SOUTH ST. PAUL, |
| Zip Code | 55075 |
Please comment or provide details below to improve the information on MR. CHARLES GLEN MICKELSON.
| 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.