Provider Demographics
NPI:1275727257
Name:LOCKHEART, MICHAEL S K (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S K
Last Name:LOCKHEART
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 SAINT ANTHONY AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7632
Mailing Address - Country:US
Mailing Address - Phone:651-968-5600
Mailing Address - Fax:
Practice Address - Street 1:1661 SAINT ANTHONY AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-968-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51372-202083P0901X
ND135202083X0100X
MN502822083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN720809Medicare UPIN
WI004670001Medicare UPIN