Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Michael Alan Blackburn, DO

Individual provider Family Medicine Physician · NPI 1619389525

Dr. Michael Alan Blackburn, DO is a Family Practice in St Louis Park, Minnesota. Qualified in 2013, 13 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
13
Licensed in
MN
In the registry since
2014
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

3850 Park Nicollet Blvd
St Louis Park, MN 55416-2527
Phone: (952) 883-1000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4730 Chicago Ave, Minneapolis, MN 55407-3570 — (952) 967-7676

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 59660 (MN)

Record details

NPI number1619389525
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMay 27, 2014
Last updated in NPPESJuly 16, 2021
Certification dateJuly 16, 2021
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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