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1407101538
MITCHELL JOHN FOGAL
WACONIA, MN
NPI
1407101538
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MN 11173)
Enumeration Date
2012-07-15
Last Update Date
2013-01-22
Business Address
Mr. MITCHELL JOHN FOGAL PA-C
560 S MAPLE ST STE 200 SUITE 200
WACONIA, MN 55387-1757
Phone number: 952-442-2163
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Mailing Address
Mr. MITCHELL JOHN FOGAL PA-C
4200 DAHLBERG DR STE 300 SUITE 300
GOLDEN VALLEY, MN 55422-4841
Phone number: 952-512-5637
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