Provider Demographics
NPI:1316142128
Name:GEPPERT, MICHAEL PAUL (BA, MOM, LAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:GEPPERT
Suffix:
Gender:M
Credentials:BA, MOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 13TH AVE N STE 201
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1036
Mailing Address - Country:US
Mailing Address - Phone:320-309-0892
Mailing Address - Fax:
Practice Address - Street 1:4 13TH AVE N STE 201
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1036
Practice Address - Country:US
Practice Address - Phone:320-309-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1328171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist