Healthcare Provider Details

I. General information

NPI: 1861624520
Provider Name (Legal Business Name): MR. PAUL HENRY ALTHOFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2009
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 OLINGER CIR
EDINA MN
55436-1944
US

IV. Provider business mailing address

6016 OLINGER CIR
EDINA MN
55436-1944
US

V. Phone/Fax

Practice location:
  • Phone: 612-822-0756
  • Fax: 952-922-5010
Mailing address:
  • Phone: 612-822-0756
  • Fax: 952-922-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberNA
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: