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General NPI Number Information
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NPI Number | 1811408750
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Entity Type | Individual
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Provider Name | MADELINE WELTER KALTHOFF PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 6405 FRANCE AVE S STE W440
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City | EDINA
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State | MN
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Zip | 55435-2190
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Country | US
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Telephone | 952-927-7004
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Fax | 952-927-5146
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Provider Business Mailing Address
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Address Line | MADELINE KALTHOFF, CENTRACARE CLINIC 1200 6TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303
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Country | US
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Telephone | 320-252-5131
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MN
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