Healthcare Provider Details

I. General information

NPI: 1598899114
Provider Name (Legal Business Name): CORNER MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 FLUEGER CT
RED WING MN
55066-1996
US

IV. Provider business mailing address

573 FLUEGER COURT
RED WING MN
55066
US

V. Phone/Fax

Practice location:
  • Phone: 651-267-2414
  • Fax: 651-388-7262
Mailing address:
  • Phone: 651-267-2414
  • Fax: 651-388-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6217702
License Number StateMN

VIII. Authorized Official

Name: MR. DAN STEINHAUSER
Title or Position: PRESIDENT
Credential:
Phone: 763-535-5335