Individual
DR. MICHAEL RAY BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 CURVE CREST BLVD W, STILLWATER, MN 55082-6040
(651) 439-1234
(651) 275-3325
Mailing address
8170 33RD AVE S # MS 21110Q, MINNEAPOLIS, MN 55425-4516
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
445
MN
213E00000X
Podiatrist
746
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
445
MN
213ES0103X
Foot & Ankle Surgery Podiatrist
746
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164225100
—
MN
05
—
43222300
—
WI
Enumeration date
10/25/2005
Last updated
04/23/2026
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