Healthcare Provider Details

I. General information

NPI: 1447282520
Provider Name (Legal Business Name): WILLIAM PAUL PASCHKE P.A.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1901 CONNECTICUT AVE. S
SARTELL MN
56377
US

IV. Provider business mailing address

1901 CONNECTICUT AVE. 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 Code363A00000X
TaxonomyPhysician Assistant
License Number10061
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: