Individual
MICHAEL DAVID HISCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1301 33RD ST S STE 210, SAINT CLOUD, MN 56301-9668
(320) 240-6955
(320) 240-8089
Mailing address
1301 33RD ST S STE 210, SAINT CLOUD, MN 56301-9668
(320) 240-6955
(320) 240-8089
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7234
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011625400
—
MN
01
—
120L4HI
BLUE CROSS BLUE SHIELD
MN
01
—
264M1NO
BLUE CROSS BLUE SHIELD OF MN
MN
01
—
6404175
MEDICA
MN
01
—
HP39133
HEALTHPARTNERS
MN
Enumeration date
11/22/2006
Last updated
02/05/2018
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