Healthcare Provider Details

I. General information

NPI: 1588870703
Provider Name (Legal Business Name): CENTRAL MINNESOTA FOOT & ANKLE ASSOCIATES,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 NORTHWAY DR SUITE 130
SAINT CLOUD MN
56303-1940
US

IV. Provider business mailing address

1545 NORTHWAY DR SUITE 130
SAINT CLOUD MN
56303-1940
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-2963
  • Fax: 320-252-4206
Mailing address:
  • Phone: 320-252-2963
  • Fax: 320-252-4206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number434
License Number StateMN

VIII. Authorized Official

Name: DR. DAVID CONRAD SCHLEICHERT
Title or Position: OWNER
Credential: DPM
Phone: 320-252-2963