Individual
WALTER LO SIA SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 6TH AVE N, CENTRA CARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Mailing address
1200 6TH AVE N, CENTRA CARE CLINIC, ST CLOUD, MN 56303-2735
(320) 251-2700
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
37684
MN
208M00000X
Hospitalist Physician
Primary
37684
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0407506
MEDICA HEALTH PLANS
—
01
—
1013234
PREFERRED ONE
—
01
—
114449
UCARE
—
01
—
242513100
MEDICAL ASSISTANCE
—
05
—
242513100
—
MN
01
—
379K3S1
BLUE CROSS BLUE SHIELD
—
01
—
526021
ARAZ GROUP AMERICAS PPO
—
01
—
HP21690
HEALTH PARTNERS
—
Enumeration date
10/14/2005
Last updated
12/21/2015
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