Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 44473 | MN |
NPI | 1710074232 |
---|---|
Provider Name | Michael E Pinchback |
First Address | Robbinsdale, MN 55422-2948 |
Second Address | Saint Paul, MN 55104-4543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 16/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
082235300 | (05) | MN |
H63354 | (02) | MN |