Individual
MR. MICHAEL JAMES MAHONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
215 PARK AVE S, SUITE 101, SAINT CLOUD, MN 56301-3736
(320) 252-0452
Mailing address
215 PARK AVE S, SUITE 101, SAINT CLOUD, MN 56301-3736
(320) 252-0452
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
2067
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110204
—
MN
05
—
45-00200
—
MN
05
—
45-80212
—
MN
01
—
55030CL
BLUE CROSS& BLUE SHIELD
MN
05
—
82-81124
—
MN
Enumeration date
02/26/2007
Last updated
07/09/2007
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