Healthcare Provider Details

I. General information

NPI: 1083638761
Provider Name (Legal Business Name): ST. CLOUD ORTHOPEDIC ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CONNECTICUT AVENUE S
SARTELL MN
56377
US

IV. Provider business mailing address

1901 CONNECTICUT AVENUE S
SARTELL MN
56377
US

V. Phone/Fax

Practice location:
  • Phone: 320-259-4100
  • Fax: 320-259-8044
Mailing address:
  • Phone: 320-259-4100
  • Fax: 320-259-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number251
License Number StateMN

VIII. Authorized Official

Name: MITCHELL KUHL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 320-259-4100