Active NPI 1891778163 Individual Practitioner Male Practitioner

Dr. Daniel Kevin Elieff , MD

Dermatology • Saint Cloud, MN

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Daniel Elieff, MD is a certified Dermatology practicing in Saint Cloud, MN. With approximately 35 years of clinical experience since graduating from University Of Minnesota Medical School in 1991, Dr. Elieff delivers high-quality medical care to the local community at 1510 24TH AVE N.

Dr. Elieff is affiliated with Midwest Clinic Of Dermatology Laser And Cosmetic Surgery Pa and accepts Medicare assignment.

Frequently performed procedures and clinical services include removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks, destruction of precancer skin growth, 2-14 growths, removal and microscopic exam of growth of head, neck, hands, feet, or genitals. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1510 24th Ave N

Saint Cloud, MN 563031304

Telephone 3202590208

Fax 3202590715

Associated Practice Facility / Clinic

🏢 Midwest Clinic Of Dermatology Laser And Cosmetic Surgery Pa Facility NPI 1811092398

Medicare Profile & Education

Medical School

University Of Minnesota Medical School

Graduation Year

1991

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Saint Cloud, MN

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

35 Yrs +11.0 yrs vs City Avg

City Avg: 24.0 Yrs

State Avg: 20.4 Yrs

Regional Practice Density

5 Specialists

Practicing in Saint Cloud, MN (337 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

60.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Elieff (35 Years) 35 Yrs

Saint Cloud Specialty Average (24.0 Years) 24.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	192	149	$1348.64	$623.82
17003 Destruction of precancer skin growth, 2-14 growths	160	29	$13.50	$6.64
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	124	94	$820.77	$401.92
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	72	62	$251.90	$124.23
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	69	59	$924.65	$231.01
99213 Established patient office or other outpatient visit, typically 15 minutes	66	57	$178.55	$88.05
17110 Destruction of up to 14 skin growths	41	36	$228.70	$105.84
17000 Destruction of skin growth	41	38	$134.65	$43.68
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	40	33	$838.65	$227.26
17004 Destruction of precancer skin growth, 15 or more growths	39	35	$333.14	$164.21
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	35	25	$1268.97	$607.40
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	20	14	$786.30	$387.18
11102 Tangential biopsy of single skin lesion	17	17	$200.06	$66.76
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	15	15	$972.84	$239.33

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	433	65	$15.24	$6.78
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	164	133	$1457.48	$628.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	150	124	$269.83	$124.63
99213 Established patient office or other outpatient visit, typically 15 minutes	124	102	$196.16	$88.26
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	105	85	$896.25	$409.12
17004 Destruction of precancer skin growth, 15 or more growths	94	79	$373.35	$167.83
17000 Destruction of skin growth	84	78	$147.00	$42.43
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	83	73	$1024.05	$243.97
17110 Destruction of up to 14 skin growths	77	67	$255.65	$106.65
11102 Tangential biopsy of single skin lesion	72	64	$237.31	$72.71
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	49	40	$947.85	$270.99
11103 Biopsy of related skin growth, each additional growth	41	28	$116.56	$50.14
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	37	30	$1481.25	$623.27
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	32	27	$946.31	$301.92
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	16	$372.18	$85.01
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	16	16	$1115.25	$274.81
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	12	12	$926.46	$392.75

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	3,200	16	$4.75	$1.57
17003 Destruction of precancer skin growth, 2-14 growths	991	176	$20.97	$6.89
99213 Established patient office or other outpatient visit, typically 15 minutes	274	253	$271.14	$89.35
17000 Destruction of skin growth	229	217	$203.67	$43.95
17110 Destruction of up to 14 skin growths	192	180	$348.00	$110.53
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	176	139	$2040.21	$589.28
17004 Destruction of precancer skin growth, 15 or more growths	175	163	$515.76	$170.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	162	145	$383.58	$126.59
11102 Tangential biopsy of single skin lesion	149	135	$315.09	$79.20
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	132	94	$1247.22	$411.58
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	76	67	$1437.63	$240.22
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	72	57	$1302.51	$259.71
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	40	31	$1918.29	$616.67
11103 Biopsy of related skin growth, each additional growth	36	28	$156.60	$51.77
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	34	30	$1219.38	$355.92
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	25	25	$332.19	$109.61
11200 Removal of skin tag, 1-15 skin tags	24	24	$273.54	$48.98
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	23	21	$524.91	$86.88
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	22	22	$1509.60	$272.55
96574 Application of light with debridement to destroy precancer skin growth	16	16	$890.88	$293.84
17111 Destruction of skin growth, 15 or more growths	15	14	$406.20	$129.41
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	15	15	$495.36	$163.36
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	13	12	$168.84	$55.83

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	570	99	$10.75	$6.70
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	242	170	$840.96	$609.41
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	154	134	$144.49	$128.51
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	140	100	$507.09	$416.23
99213 Established patient office or other outpatient visit, typically 15 minutes	135	122	$113.81	$90.64
17000 Destruction of skin growth	134	120	$95.30	$47.10
17004 Destruction of precancer skin growth, 15 or more growths	130	109	$205.66	$167.82
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	129	110	$712.86	$244.00
11102 Tangential biopsy of single skin lesion	103	83	$130.95	$80.48
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	89	73	$520.67	$291.46
17110 Destruction of up to 14 skin growths	86	76	$137.12	$112.64
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	50	38	$693.24	$629.05
11103 Biopsy of related skin growth, each additional growth	49	39	$72.16	$53.69
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	41	37	$483.72	$336.20
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	28	26	$668.87	$254.75
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	23	20	$391.89	$153.98
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	21	18	$405.49	$398.65
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	14	13	$195.25	$87.44
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$335.70	$125.09
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	13	13	$1529.25	$988.99
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$131.94	$111.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	727	120	$9.95	$6.17
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	271	192	$734.90	$573.00
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	201	137	$439.12	$399.80
17000 Destruction of skin growth	153	142	$85.90	$48.95
99213 Established patient office or other outpatient visit, typically 15 minutes	142	129	$76.45	$74.61
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	136	124	$115.11	$108.29
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	124	102	$624.36	$240.34
17004 Destruction of precancer skin growth, 15 or more growths	102	88	$187.44	$159.77
11102 Tangential biopsy of single skin lesion	88	82	$105.73	$82.22
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	82	66	$473.15	$306.35
17110 Destruction of up to 14 skin growths	80	75	$117.26	$112.66
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	79	64	$427.04	$356.37
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	54	41	$675.29	$607.14
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	46	39	$260.27	$124.52
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	38	37	$614.13	$254.90
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	37	32	$45.58	$45.08
11103 Biopsy of related skin growth, each additional growth	35	27	$58.70	$53.58
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	28	26	$295.45	$140.97
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	28	27	$325.52	$282.81
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	25	25	$836.69	$769.30
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	25	24	$175.63	$82.90
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	17	16	$405.49	$383.96
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	16	15	$1023.52	$922.13
13102 Complicated repair of wound of trunk, each additional 5.0 cm or less	16	14	$120.76	$119.39
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	13	12	$1097.93	$993.40
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	11	11	$325.96	$170.44
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	11	11	$1074.78	$998.99

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	3,000	13	$1.70	$1.40
17003 Destruction of precancer skin growth, 2-14 growths	855	140	$9.93	$5.50
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	247	194	$737.54	$528.37
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	193	140	$444.05	$389.81
17000 Destruction of skin growth	181	157	$85.84	$47.65
99213 Established patient office or other outpatient visit, typically 15 minutes	154	137	$76.77	$73.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	147	134	$114.65	$107.19
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	96	77	$668.09	$612.50
17004 Destruction of precancer skin growth, 15 or more growths	96	82	$187.44	$149.68
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	85	70	$333.44	$227.25
11102 Tangential biopsy of single skin lesion	81	73	$104.65	$78.20
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	80	73	$622.79	$249.39
17110 Destruction of up to 14 skin growths	78	70	$117.26	$105.86
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	55	48	$473.15	$219.96
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	39	34	$45.58	$44.48
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	32	28	$405.49	$373.92
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	31	28	$179.14	$81.11
11103 Biopsy of related skin growth, each additional growth	29	23	$58.70	$52.85
14041 Repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet by transferring skin, 10.1-30.0 sq cm	25	23	$1023.52	$917.23
13152 Complicated repair of wound of eyelids, nose, ears, or lip, 2.6-7.5 cm	22	22	$602.75	$249.37
14061 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.1-30.0 sq cm	22	21	$1144.07	$956.82
15260 Relocation of patient skin to nose, ears, eyelids, and/or lips (20 sq centimeters or less)	19	19	$1137.12	$988.31
11200 Removal of skin tag, 1-15 skin tags	17	17	$89.60	$64.30
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	16	16	$836.69	$710.98
13122 Complicated repair of wound of scalp, arms, or legs, each additional 5.0 cm or less	14	14	$135.02	$129.45
88305 Pathology examination of tissue using a microscope, intermediate complexity	14	11	$153.15	$55.02

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	551	73	$9.95	$4.84
17000 Destruction of skin growth	95	80	$86.31	$44.84
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	87	75	$732.19	$483.40
99213 Established patient office or other outpatient visit, typically 15 minutes	75	71	$77.60	$67.65
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	72	60	$116.24	$99.88
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	66	50	$437.57	$361.81
17004 Destruction of precancer skin growth, 15 or more growths	55	40	$193.13	$132.78
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	51	44	$329.92	$240.44
11100 Biopsy of single growth of skin and/or tissue	50	45	$111.80	$82.21
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	38	30	$668.09	$567.03
17110 Destruction of up to 14 skin growths	37	32	$118.47	$99.63
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	28	26	$175.02	$80.46
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	26	23	$622.79	$220.40
11101 Biopsy of each additional growth of skin and/or tissue	24	16	$38.00	$29.96
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	21	$45.58	$40.89
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	14	11	$405.49	$345.66
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	14	12	$473.15	$226.52
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	11	11	$424.46	$217.49
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	11	11	$836.69	$714.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	362	57	$9.95	$5.14
17311 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks	110	88	$740.86	$477.35
17312 Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks	92	65	$457.95	$347.13
17000 Destruction of skin growth	81	74	$85.90	$46.77
99213 Established patient office or other outpatient visit, typically 15 minutes	74	68	$76.45	$67.76
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	66	58	$114.65	$99.05
17004 Destruction of precancer skin growth, 15 or more growths	47	39	$187.44	$138.19
17313 Removal and microscopic exam of growth of trunk, arms, or legs, 1-5 tissue blocks	43	35	$668.09	$555.01
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	40	33	$325.52	$216.36
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	40	35	$622.79	$217.88
11100 Biopsy of single growth of skin and/or tissue	38	33	$112.16	$75.87
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	24	$45.58	$40.18
17110 Destruction of up to 14 skin growths	24	21	$117.26	$103.60
17314 Removal and microscopic exam of growth of trunk, arms, or legs, each additional stage, 1-5 tissue blocks	22	18	$405.49	$343.56
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	18	13	$169.91	$76.10
14060 Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less	16	15	$887.90	$642.61
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	16	15	$473.15	$244.78

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License MN 38413

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Hospital & Practice Group Affiliations

Midwest Clinic Of Dermatology Laser And Cosmetic Surgery Pa

1510 24th Ave N, Saint Cloud, MN 563031304

Phone: 3202590208

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

2 Associated Practitioners

Sarah Tasto , APRN-CNP

Nurse Practitioner

NPI 1467062133

Advanced Practice Registered Nurse - Certified Nurse Practitioner

Gerald Taylor , PA-C

Physician Assistant

NPI 1588647853

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 1510 24TH AVE N, SAINT CLOUD, MN 563031304 (Tel: 3202590208)

📍

Updated Business Mailing Address July 08, 2007

Registered at 1510 24TH AVE N, SAINT CLOUD, MN 563031304 (Tel: 3202590208)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as DANIEL ELIEFF, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dermatology (License #38413 in MN)

🟢

Initial NPI Registration & Enumeration November 21, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1891778163

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: November 21, 2005

Last Update: July 13, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1510 24th Ave N

Saint Cloud, MN 563031304

Phone: 3202590208

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.