Healthcare Provider Details

I. General information

NPI: 1336505429
Provider Name (Legal Business Name): JOHN MICHAEL STINGLE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 TRETTEL LN
CLOQUET MN
55720-1345
US

IV. Provider business mailing address

927 TRETTEL LN
CLOQUET MN
55720-1345
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1227
  • Fax: 218-451-5957
Mailing address:
  • Phone: 218-879-1227
  • Fax: 765-973-9233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0009530
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15161
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3591
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: