Healthcare Provider Details

I. General information

NPI: 1932702644
Provider Name (Legal Business Name): SENSORIA MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

IV. Provider business mailing address

48 29TH AVE N
SAINT CLOUD MN
56303-4589
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-0300
  • Fax: 320-240-0303
Mailing address:
  • Phone: 320-240-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BALFANZ
Title or Position: OWNER
Credential: DC
Phone: 320-240-0300