Organization
MIDSOTA PLASTIC AND RECONSTRUCTIVE SURGEONS PA
Active
Other names
Midsota Plastic Surgeons
Organization subpart
No
Provider details
NPI number
Authorized official
ENNIS H ARNSTON (EXECUTIVE DIRECTOR)
(320) 253-7257
Entity
Organization
Contact information
Practice address
3701 12TH ST N, SUITE 100, SAINT CLOUD, MN 56303-2255
(320) 253-7257
(320) 251-2938
Mailing address
3701 12TH ST N, SUITE 100, SAINT CLOUD, MN 56303-2255
(320) 253-7257
(320) 251-2938
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07537
METRAHEALTH MPIN
—
01
—
108167
UCARE
—
01
—
192212200
NEW MA PROVIDER
—
01
—
53242MI
BCBS
—
Enumeration date
07/18/2006
Last updated
02/25/2010
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