Provider Demographics
NPI:1386528586
Name:LINK, MICAH KENNETH (PA-C)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:KENNETH
Last Name:LINK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 N TREE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROSHOLT
Mailing Address - State:WI
Mailing Address - Zip Code:54473-8700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12940 HARRIET AVE S STE 220
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2794
Practice Address - Country:US
Practice Address - Phone:612-888-9247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN15425363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant