Healthcare Provider Details

I. General information

NPI: 1861540064
Provider Name (Legal Business Name): MILESTONE THERAPEUTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 43RD AVE N
FARGO ND
58102-5320
US

IV. Provider business mailing address

921 43RD AVE N
FARGO ND
58102-5320
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-3646
  • Fax: 701-293-6892
Mailing address:
  • Phone: 701-793-3646
  • Fax: 701-293-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN PRESTON OLSON
Title or Position: PRESIDENT
Credential: OTRL
Phone: 701-793-3646