Healthcare Provider Details

I. General information

NPI: 1942119169
Provider Name (Legal Business Name): MICHAEL COLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 DUCKWOOD DR STE 500
EAGAN MN
55122-1399
US

IV. Provider business mailing address

1440 DUCKWOOD DR STE 500
EAGAN MN
55122-1399
US

V. Phone/Fax

Practice location:
  • Phone: 715-307-8774
  • Fax:
Mailing address:
  • Phone: 715-307-8774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: