Provider Demographics
NPI:1497922264
Name:SINGLETON, MIKE
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:
Last Name:SINGLETON
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 1:6625 379TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5852
Mailing Address - Country:US
Mailing Address - Phone:651-895-9836
Mailing Address - Fax:
Practice Address - Street 1:6625 379TH CT
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5852
Practice Address - Country:US
Practice Address - Phone:651-895-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker