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6625 Lyndale Ave S Ste 105, Minneapolis, MN 55423-2673 | |
| (612) 788-8778 | |
| (612) 869-3473 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Podiatrist |
| Location | 6625 Lyndale Ave S Ste 105, Minneapolis, Minnesota |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689848392 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | 631 (Minnesota) | Primary |
| 213E00000X | Podiatrist | (* (Not Available)) | Secondary |
| 335E00000X | Prosthetic/orthotic Supplier | 631 (Minnesota) | Secondary |
| Provider Name | Dale Herbert Vancil |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1205856713 PECOS PAC ID: 5395649578 Enrollment ID: I20031120000214 |
| Provider Name | Michael Debrule |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1689655722 PECOS PAC ID: 4082695747 Enrollment ID: I20040527001000 |
| Provider Name | Thomas E Silver |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1447264031 PECOS PAC ID: 1153341011 Enrollment ID: I20051207000124 |
| Provider Name | Glenn R Meints |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1265514731 PECOS PAC ID: 2062512304 Enrollment ID: I20070716000272 |
| Provider Name | Dana Brewington |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1205933553 PECOS PAC ID: 5294735239 Enrollment ID: I20071018000104 |
| Provider Name | Minh-chau M Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1760465215 PECOS PAC ID: 7517053788 Enrollment ID: I20071018000721 |
| Provider Name | Bryan Mohr |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1043215528 PECOS PAC ID: 8527070937 Enrollment ID: I20080602000712 |
| Provider Name | David Edward Jones |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1639163405 PECOS PAC ID: 6507824778 Enrollment ID: I20110203001135 |
| Provider Name | Eric W Affeldt |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1225144850 PECOS PAC ID: 6709062698 Enrollment ID: I20110510000474 |
| Provider Name | Mary E Jaeger |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1891129425 PECOS PAC ID: 4385867142 Enrollment ID: I20140523000225 |
| Provider Name | Anne E Massey |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1942599006 PECOS PAC ID: 9335374479 Enrollment ID: I20150306002104 |
| Provider Name | Eric Nelson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1184028193 PECOS PAC ID: 4880963628 Enrollment ID: I20170710002846 |
| Provider Name | Karimah Z Shabazz |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1134412802 PECOS PAC ID: 3577881697 Enrollment ID: I20180612000561 |
| Provider Name | Todd Aaron Peabody |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1750720876 PECOS PAC ID: 9739471939 Enrollment ID: I20180731000630 |
| Provider Name | Brent James Larson |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1659759082 PECOS PAC ID: 2062762479 Enrollment ID: I20180906000273 |
| Provider Name | Lisa Thatcher |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1922450618 PECOS PAC ID: 2365785904 Enrollment ID: I20190522000663 |
| Provider Name | Marlene Bonilla Alicea |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1588856546 PECOS PAC ID: 9436316817 Enrollment ID: I20190613000730 |
| Provider Name | Darrick William Proehl |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629417506 PECOS PAC ID: 2365768504 Enrollment ID: I20191008000107 |
| Provider Name | Nicholas Staub |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1790274066 PECOS PAC ID: 8921404690 Enrollment ID: I20210903000541 |
| Provider Name | Kathryn Christine Jenewein |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1073870192 PECOS PAC ID: 3274838214 Enrollment ID: I20211018002461 |
| Provider Name | Tran Bao Nguyen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1326600123 PECOS PAC ID: 7911389051 Enrollment ID: I20220805000281 |
| Provider Name | Michael Lee Vallez |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1215440854 PECOS PAC ID: 5294106977 Enrollment ID: I20230116000981 |
| Provider Name | John Matthew Thomas |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1033471990 PECOS PAC ID: 9032417829 Enrollment ID: I20230831002859 |
| Mailing Address | Practice Location Address |
|---|---|
6625 Lyndale Ave S Ste 300, Minneapolis, MN 55423-2491 Ph: (612) 788-8778 | 6625 Lyndale Ave S Ste 105, Minneapolis, MN 55423-2673 Ph: (612) 788-8778 |
Todd Arnold Shea, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 825 Nicollet Mall Ste 300, Minneapolis, MN 55402 Phone: 612-333-8883 | |
Downtown Skyway Foot Specialists Inc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 825 Nicollet Mall, Suite 517 Medical Arts Bldg, Minneapolis, MN 55402 Phone: 612-332-7720 Fax: 612-333-8981 | |
Dennis Jay Oeltjenbruns, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 800 E 28th St, Minneapolis, MN 55407 Phone: 952-946-9777 | |
Dr. Tanler Juris Volkmann, DPM Podiatrist Medicare: Medicare Enrolled Practice Location: 800 E 28th St, Minneapolis, MN 55407 Phone: 612-863-3110 Fax: 612-863-3158 | |
Dr. Lisa Lee Cummings, D.P.M. Podiatrist Medicare: Medicare Enrolled Practice Location: 7801 E Bush Lake Rd Ste 400, Minneapolis, MN 55439 Phone: 952-283-3162 Fax: 866-991-7241 | |
Dr. Gregory Todd Rifleman, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1 Veterans Drive, Minneapolis, MN 55417 Phone: 612-467-4685 |