Healthcare Provider Details

I. General information

NPI: 1073540902
Provider Name (Legal Business Name): AUSTIN & TREACY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST 800 MEDICAL ARTS
DULUTH MN
55802-1701
US

IV. Provider business mailing address

324 W SUPERIOR ST 800 MEDICAL ARTS
DULUTH MN
55802-1701
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-6655
  • Fax: 218-722-8582
Mailing address:
  • Phone: 218-722-6655
  • Fax: 218-722-8582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number813
License Number StateMN

VIII. Authorized Official

Name: CARIN B ENGLER
Title or Position: INSURANCE SPECIALIST
Credential:
Phone: 218-722-6655