Moen, Clinton T

Moen, Clinton T is an individual health care provider with primary practice located at 2711 E 5Th St , Duluth MN 55812. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Moen, Clinton T can be contacted via phone (218) 724-0649.

Contact Information

Primary practice address
2711 E 5Th St Duluth MN 55812
Phone: (218) 724-0649
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 25367 Wisconsin

Profile Details

NPI number 1063401297
LBN Legal business name Moen, Clinton T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2005
Last updated Jan 20th, 2015 - about 11 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 1063401297 NPPES
Wisconsin MEDICAID 30451200

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