Bourne, Michael Ray

Bourne, Michael Ray is an individual health care provider with primary practice located at 1500 Curve Crest Blvd W , Stillwater MN 55082-6040. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Bourne, Michael Ray can be contacted via phone (651) 439-1234.

Contact Information

Primary practice address
1500 Curve Crest Blvd W Stillwater MN 55082-6040
Phone: (651) 439-1234
Fax: (651) 275-3325
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 746 Wisconsin
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 746 Wisconsin
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 445 Minnesota
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 445 Minnesota

Profile Details

NPI number 1164412649
LBN Legal business name Bourne, Michael Ray
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2005
Last updated Jun 4th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164412649 NPPES
Minnesota MEDICAID 164225100
Minnesota MEDICAID 43222300

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