Healthcare Provider Details

I. General information

NPI: 1407290604
Provider Name (Legal Business Name): FRANCES TEPOLT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR STE 200
SAINT CLOUD MN
56303-4913
US

IV. Provider business mailing address

1555 NORTHWAY DR STE 200
SAINT CLOUD MN
56303-4913
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-3157
  • Fax: 320-240-3164
Mailing address:
  • Phone: 320-240-3157
  • Fax: 320-240-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66161
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: