Healthcare Provider Details

I. General information

NPI: 1992648257
Provider Name (Legal Business Name): MICHAEL VINCENT SENTKEWITZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11318 86TH AVE N
MAPLE GROVE MN
55369-4528
US

IV. Provider business mailing address

2415 N ADAMS ST
SPOKANE WA
99205-3406
US

V. Phone/Fax

Practice location:
  • Phone: 612-314-5286
  • Fax:
Mailing address:
  • Phone: 612-314-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number202957
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: