Healthcare Provider Details

I. General information

NPI: 1023940244
Provider Name (Legal Business Name): MICHAEL TINGUELY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N EISENHOWER AVE
MASON CITY IA
50401-1552
US

IV. Provider business mailing address

5884 CROSSANDRA ST SE
PRIOR LAKE MN
55372-3337
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-7000
  • Fax:
Mailing address:
  • Phone: 612-570-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: