Individual
MR. CODY DANIEL TUCHOLKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1415 LILAC DR N STE 190, MINNEAPOLIS, MN 55422-4544
(763) 267-8701
Mailing address
1856 YORKSHIRE AVE, SAINT PAUL, MN 55116-2404
(612) 269-6187
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14001
PA LICENSE
MN
Enumeration date
02/22/2022
Last updated
03/07/2023
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