MEDICARE: DR. CYNTHIA MARIE HUNTIMER M.D., M.P.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	49154	MN

General Provider Information

NPI Number	:	1366492696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA MARIE HUNTIMER M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1321 13TH ST N
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-2613
Country	:	US
Telephone Number	:	320-252-5010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1772 STIEGER LAKE LN STE 220
Second Line	:
City	:	VICTORIA
State	:	MN
Zip	:	55386-7723
Country	:	US
Telephone Number	:	952-443-4600
Fax Number	:	952-443-4604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	10/29/2018

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