Organization
PREMIER PHYSICAL HEALTHCARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RYAN MICHAELS (OWNER)
(218) 262-3315
Entity
Organization
Contact information
Practice address
115 W HOWARD ST, HIBBING, MN 55746-1548
(218) 262-3315
(218) 263-9648
Mailing address
115 W HOWARD ST, HIBBING, MN 55746-1548
(218) 262-3315
(218) 263-9648
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
29671
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811267214
BLUE CROSS BLUE SHIELD MN
MN
05
—
1811267214
—
MN
Enumeration date
01/03/2012
Last updated
10/31/2012
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