Healthcare Provider Details

I. General information

NPI: 1629381314
Provider Name (Legal Business Name): CHAD M ENGELHART PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 09/22/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N RITCHIE MEDICAL PLAZA #330
SAINT PAUL MN
55102-2393
US

IV. Provider business mailing address

310 SMITH AVE N RITCHIE MEDICAL PLAZA #330
SAINT PAUL MN
55102-2393
US

V. Phone/Fax

Practice location:
  • Phone: 651-227-6351
  • Fax:
Mailing address:
  • Phone: 651-227-6351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10739
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: