Healthcare Provider Details

I. General information

NPI: 1114533908
Provider Name (Legal Business Name): DR. KELSEY MILBERT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 E MINNESOTA ST
SAINT JOSEPH MN
56374-8618
US

IV. Provider business mailing address

PO BOX 607
SAINT JOSEPH MN
56374-0607
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-7729
  • Fax: 320-363-0308
Mailing address:
  • Phone: 320-363-7729
  • Fax: 320-363-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELE SCHRAMEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-363-7729