Healthcare Provider Details

I. General information

NPI: 1912369141
Provider Name (Legal Business Name): ALICE RINGHEIM KNOEDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICE RINGHEIM STODDART

II. Dates (important events)

Enumeration Date: 03/26/2016
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 RADIO DR
WOODBURY MN
55125-5805
US

IV. Provider business mailing address

215 RADIO DR STE 202
WOODBURY MN
55125-5822
US

V. Phone/Fax

Practice location:
  • Phone: 651-702-0750
  • Fax: 651-645-6166
Mailing address:
  • Phone: 651-702-0750
  • Fax: 651-645-6166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68834
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number68834
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: