Healthcare Provider Details

I. General information

NPI: 1700798014
Provider Name (Legal Business Name): MICAH ALFRED HUNSKOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 2ND ST SW
ROCHESTER MN
55902-1906
US

IV. Provider business mailing address

2764 KNOLLWOOD DR SE
ROCHESTER MN
55904-6916
US

V. Phone/Fax

Practice location:
  • Phone: 507-990-9407
  • Fax:
Mailing address:
  • Phone: 507-990-9407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2529552
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: