Individual
DR. SAM ANDREW MIOTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-1669
Mailing address
8170 33RD AVE S, BLOOMINGTON, MN 55425-4516
(651) 254-1669
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
59198
MN
208600000X
Surgery Physician
Primary
59198
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2012
Last updated
08/04/2020
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