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

Mr. Charles Glen Mickelson, CPED

Individual provider Pedorthist · NPI 1568773679

Mr. Charles Glen Mickelson, CPED is a Pedorthist in South St Paul, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.

Licensed in
MN
In the registry since
2010
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Practice location Address checks out

423 12th Ave N
South St Paul, MN 55075-1915
Phone: (651) 291-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pedorthist (primary) Taxonomy 224L00000X (MN)

Record details

NPI number1568773679
Entity typeIndividual (Type 1)
GenderMale
Credentials CPED
Sole proprietorYes
NPI enumeratedJune 24, 2010
Last updated in NPPESNovember 9, 2010