| Doctor Name: | DR. MICHAEL ALAN BLACKBURN |
| NPI Number: | 1619389525 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | |
| Business Practice Address: | 6600 Excelsior Blvd Suite 160 St Louis Park, MN - 554264744 |
| Business Phone Number: | 9529937711 |
| Business Fax Number: | |
| Mailing Address: | 6600 Excelsior Blvd, Suite 160 ST LOUIS PARK |
| State: | MN |
| Postal Code: | 554264744 |
| Phone Number: | 9529937711 |
| Fax Number: | |
| NPI Enumeration Date: | 05/27/2014 |
| NPI Last Update Date: | 05/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |