Organization
ST CLOUD MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER TACL MD (MEDICAL DIRECTOR)
(320) 202-8949
Entity
Organization
Contact information
Practice address
251 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-8949
(320) 202-0756
Mailing address
251 COUNTY ROAD 120, SAINT CLOUD, MN 56303-4872
(320) 202-8949
(320) 202-0756
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175710500
—
MN
Enumeration date
06/22/2006
Last updated
10/06/2011
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