Provider Demographics
NPI:1093893992
Name:NATION, MICHAEL K
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:NATION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 AFTON RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MD
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:631-738-0470
Mailing Address - Fax:651-738-8915
Practice Address - Street 1:393 N DUNLAP ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-645-4693
Practice Address - Fax:651-645-6503
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28782208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F13647Medicare UPIN