Healthcare Provider Details

I. General information

NPI: 1316142128
Provider Name (Legal Business Name): MICHAEL PAUL GEPPERT B.A., M.OM, L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 13TH AVE N STE 201
WAITE PARK MN
56387-1036
US

IV. Provider business mailing address

4 13TH AVE N STE 201
WAITE PARK MN
56387-1036
US

V. Phone/Fax

Practice location:
  • Phone: 320-309-0892
  • Fax:
Mailing address:
  • Phone: 320-309-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1328
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: