Healthcare Provider Details

I. General information

NPI: 1811408750
Provider Name (Legal Business Name): MADELINE WELTER KALTHOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 FRANCE AVE S STE W440
EDINA MN
55435-2190
US

IV. Provider business mailing address

MADELINE KALTHOFF, CENTRACARE CLINIC 1200 6TH AVE N
SAINT CLOUD MN
56303
US

V. Phone/Fax

Practice location:
  • Phone: 952-927-7004
  • Fax: 952-927-5146
Mailing address:
  • Phone: 320-252-5131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: