MEDICARE: MICHELLE LYNN KITSMILLER-CLIFTON L.AC. MA.O.M

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
1	171100000X	Acupuncturist	1520	MN

General Provider Information

NPI Number	:	1861727679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN KITSMILLER-CLIFTON L.AC. MA.O.M

Provider Business Mailing Address
First Line	:	3300 LYNDALE AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3656
Country	:	US
Telephone Number	:	651-248-2608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 LYNDALE AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3656
Country	:	US
Telephone Number	:	651-248-2608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	07/20/2010

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