Healthcare Provider Details

I. General information

NPI: 1346251527
Provider Name (Legal Business Name): MICHAEL E BISHOP DC, MPAS, MBA, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/08/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 310TH AVENUE
MAHNOMEN MN
56557
US

IV. Provider business mailing address

40520 COUNTY HIGHWAY 34
OGEMA MN
56569-9612
US

V. Phone/Fax

Practice location:
  • Phone: 218-935-2238
  • Fax: 218-935-5085
Mailing address:
  • Phone: 218-983-4300
  • Fax: 218-983-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10779
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number694
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4088
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1435
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAC0588
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: