Healthcare Provider Details

I. General information

NPI: 1023085933
Provider Name (Legal Business Name): MICHAEL M PRIEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 23RD AVE SW
ROCHESTER MN
55902-3454
US

IV. Provider business mailing address

1141 23RD AVE SW
ROCHESTER MN
55902-3454
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-1681
  • Fax:
Mailing address:
  • Phone: 507-529-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number49216
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number49216
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: