Healthcare Provider Details

I. General information

NPI: 1639736564
Provider Name (Legal Business Name): ELIZABETH H CHIQUOINE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2019
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

345 N. SMITH AVE MAIL STOP: 70-504
SAINT PAUL MN
55102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036159717
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number73721
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number73721
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: