MEDICARE: DAVID PATENAUDE

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	213E00000X	Podiatrist	509	MN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	509	MN

General Provider Information

NPI Number	:	1558348557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID PATENAUDE

Provider Business Mailing Address
First Line	:	106 DOCTORS PARK
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1207
Country	:	US
Telephone Number	:	320-251-5444
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 DOCTORS PARK
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56303-1207
Country	:	US
Telephone Number	:	320-251-5444
Fax Number	:

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/15/2020

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Directions to “ DAVID PATENAUDE ” Practice Location

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