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

Dr. Michael Ray Bourne, MD

Individual provider Foot & Ankle Surgery Podiatrist · NPI 1164412649

Dr. Michael Ray Bourne, MD is a Podiatry in Stillwater, Minnesota. Graduated from California School of Podiatric Medicine in 1988, 38 years ago. Practices with Tria Orthopaedic Center LLC, a 506-clinician group and accepts Medicare assignment. Licensed in Minnesota and Wisconsin.

Years since qualifying
38
Trained at
California School of Podiatric Medicine
Licensed in
MN, WI
In the registry since
2005
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1500 Curve Crest Blvd W
Stillwater, MN 55082-6040
Phone: (651) 439-1234
Fax: (651) 275-3325
Show map & directions

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

Specialties & licences

Podiatrist (primary) Taxonomy 213E00000X · Licence 445 (MN)
Foot & Ankle Surgery Podiatrist Taxonomy 213ES0103X · Licence 746 (WI)
Podiatrist Taxonomy 213E00000X · Licence 746 (WI)
Foot & Ankle Surgery Podiatrist Taxonomy 213ES0103X · Licence 445 (MN)

Record details

NPI number1164412649
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedOctober 25, 2005
Last updated in NPPESApril 23, 2026
Certification dateApril 23, 2026
Mailing address8170 33rd Ave S # Ms 21110q, Minneapolis, MN 55425-4516

Medicare enrollment

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

Medicare specialtyPODIATRY
Medical schoolCALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Graduated 1988 (38 years in practice)
Group practice Tria Orthopaedic Center Llc — 506 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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