Healthcare Provider Details

I. General information

NPI: 1154559144
Provider Name (Legal Business Name): CONRAD L MEINTS & ASSOCIATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 06/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST SUITE 517
DULUTH MN
55802-1760
US

IV. Provider business mailing address

324 W SUPERIOR ST SUITE 517
DULUTH MN
55802-1760
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-0626
  • Fax: 218-722-4403
Mailing address:
  • Phone: 218-722-0626
  • Fax: 218-722-4403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number532
License Number StateMN

VIII. Authorized Official

Name: SARAH LYNN SODERHOLM
Title or Position: OFFICE MANAGER
Credential:
Phone: 218-722-0326