Michael Charles Mollen

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

26996 Issued in MN

Practice address

4855 W Arrowhead Rd
Hermantown, MN 55811-3936

Phone

(218) 786-3540

NPI assigned

Nov 28, 2006

Last updated

May 9, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1346316734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4855 W ARROWHEAD RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558113936",
            "telephone_number": "218-786-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4855 W ARROWHEAD RD",
            "city": "HERMANTOWN",
            "state": "MN",
            "postal_code": "558113936",
            "telephone_number": "218-786-3540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLLEN",
        "first_name": "MICHAEL",
        "middle_name": "CHARLES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "26996",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "316563900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Miller, BCBA
• Jennifer Mistry, PTA
• Richard William Shane Moen
• Audrielle June Mogg, BCBA
• Isabelle Molina
• Moments Hospice of Duluth LLC (Moments Hospice)
• Evan Matthew Monacelli
• Joshua Wayne Monson
• Katelyn Elizabeth Montrose
• Meaghan Elizabeth Morrell, D.D.S

• Family Medicine Physician in Hermantown, MN
• Providers in Hermantown, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.