Provider Demographics
NPI:1861624520
Name:ALTHOFF, PAUL HENRY
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:HENRY
Last Name:ALTHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6016 OLINGER CIR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1944
Mailing Address - Country:US
Mailing Address - Phone:612-822-0756
Mailing Address - Fax:952-922-5010
Practice Address - Street 1:6016 OLINGER CIR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1944
Practice Address - Country:US
Practice Address - Phone:612-822-0756
Practice Address - Fax:952-922-5010
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNNA171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN125663OtherUCARE
MN109769OtherHEALTH PARTNERS
MN4990020OtherMEDICA