MEDICARE: MS. SADIE VELEKA FORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	6NBMUB1WME	MN

General Provider Information

NPI Number	:	1376301267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SADIE VELEKA FORD

Provider Business Mailing Address
First Line	:	2112 BROADWAY ST NE STE 225
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3081
Country	:	US
Telephone Number	:	763-219-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	13588 NAGELL CIR
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-3318
Country	:	US
Telephone Number	:	176-321-9910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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