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NPI Code Detail

MEDICARE: WILFRED OAKLEY STOUT PAC

MEDICARE: WILFRED OAKLEY STOUT PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant11732MN
2363A00000XPhysician Assistant3442WI
3363AS0400XSurgical Physician Assistant3442-23WI
4363A00000XPhysician Assistant11732MN

General Provider Information

NPI Number : 1548669955
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILFRED OAKLEY STOUT PAC
Provider Business Mailing Address
First Line : 5803 NEAL AVE N
Second Line :
City : OAK PARK HEIGHTS
State : MN
Zip : 55082-2177
Country : US
Telephone Number : 651-439-8807
Fax Number : 651-439-0232
Provider Business Practice Location Address
First Line : 5803 NEAL AVE N
Second Line :
City : OAK PARK HEIGHTS
State : MN
Zip : 55082-2177
Country : US
Telephone Number : 651-439-8807
Fax Number : 651-439-0232
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2014
Last Update Date : 01/21/2026

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Directions to “ WILFRED OAKLEY STOUT PAC” Practice Location

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