Healthcare Provider Details

I. General information

NPI: 1104337617
Provider Name (Legal Business Name): LOUIS CHESTER WINSKOWSKI III CERTIFIED ORTHOTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 14TH AVE E SUITE 114
SARTELL MN
56377
US

IV. Provider business mailing address

50 14TH AVE E STE 114
SARTELL MN
56377-4653
US

V. Phone/Fax

Practice location:
  • Phone: 320-656-1363
  • Fax: 320-656-0916
Mailing address:
  • Phone: 320-656-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: