MEDICARE: MIKHAIL GOLBEN DPT

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	225100000X	Physical Therapist	10830	MN

General Provider Information

NPI Number	:	1891208245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKHAIL GOLBEN DPT

Provider Business Mailing Address
First Line	:	7551 9TH ST N STE 100
Second Line	:
City	:	OAKDALE
State	:	MN
Zip	:	55128-6628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4463 WHITE BEAR PKWY STE 108
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-7645
Country	:	US
Telephone Number	:	651-229-5486
Fax Number	:

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

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/08/2017

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Directions to “ MIKHAIL GOLBEN DPT” Practice Location

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