Healthcare Provider Details

I. General information

NPI: 1275727257
Provider Name (Legal Business Name): MICHAEL S. K. LOCKHEART MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SAINT ANTHONY AVE FL 1
SAINT PAUL MN
55104
US

IV. Provider business mailing address

1661 SAINT ANTHONY AVE FL 1
SAINT PAUL MN
55104-7632
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5600
  • Fax:
Mailing address:
  • Phone: 651-968-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number51372-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number13520
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number50282
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: