| |
2600 39th Avenue Ne, Suite 250, St. Anthony, MN 55421 | |
(612) 788-7274 | |
(612) 788-3408 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 2600 39th Avenue Ne, St. Anthony, Minnesota |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1497813190 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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1940 Greeley St S, Suite 122, Stillwater, MN 55082-5097 Ph: (651) 439-5278 | 2600 39th Avenue Ne, Suite 250, St. Anthony, MN 55421 Ph: (612) 788-7274 |