Healthcare Provider Details

I. General information

NPI: 1497922264
Provider Name (Legal Business Name): MIKE SINGLETON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 379TH CT
NORTH BRANCH MN
55056-5852
US

IV. Provider business mailing address

6625 379TH CT
NORTH BRANCH MN
55056-5852
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-9836
  • Fax:
Mailing address:
  • Phone: 651-895-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: