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Mr. Charles Glen Mickelson, CPED
Pedorthist in South St. Paul,, Minnesota
NPI 1568773679

Charles Glen Mickelson is a Pedorthist based in South St. Paul,, MN. Charles Glen Mickelson practices in South St. Paul,, MN and has the professional credentials of CPED. The NPI Number for Charles Glen Mickelson is 1568773679 and holds a License No. (Minnesota).

The current practice location address for Charles Glen Mickelson is 423 12Th Ave. North, South St. Paul,, MN and can be reached out via phone at 651-291-7000. You can also correspond with Charles Glen Mickelson through the mailing address at 423 12TH AVE. NORTH, SOUTH ST. PAUL,, MN - 55075-1915 (mailing address contact number: 651-291-7000).

Location: 423 12Th Ave. North, South St. Paul,, MN, 55075-1915
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1568773679
Provider Name
Charles Glen Mickelson
Credential
CPED
Provider Entity Type
Individual
Gender
Male
Address
423 12Th Ave. North, South St. Paul,, MN, 55075-1915
Phone Number
651-291-7000
Fax Number
Provider Enumeration Date
06/24/2010
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
423 12Th Ave. North
City
South St. Paul,
State
Minnesota
Zip
55075-1915
Phone Number
651-291-7000
Fax Number
person
Provider Business Mailing Address Details
Address
423 12Th Ave. North
City
South St. Paul,
State
Minnesota
Zip
55075-1915
Phone Number
651-291-7000
Fax Number
person
Provider's Taxonomy Details 1
Type
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Classification
Pedorthist
Speciality
-
Taxonomy
224L00000X
License No.
(Minnesota)
Definition
An individual who is trained in the management and treatment of conditions of the foot, ankle, and lower extremities requiring fitting, fabricating, and adjusting of pedorthic devices.
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