Healthcare Provider Details

I. General information

NPI: 1699363358
Provider Name (Legal Business Name): MATTHEW PAUL HORN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 10/31/2022
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 CENTRAL AVE
OSSEO MN
55369-1241
US

IV. Provider business mailing address

9201 W BROADWAY AVE STE 601
BROOKLYN PARK MN
55445-1924
US

V. Phone/Fax

Practice location:
  • Phone: 763-587-7900
  • Fax: 763-420-1901
Mailing address:
  • Phone: 763-587-7900
  • Fax: 763-587-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13598
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: