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NPI Code Detail

MEDICARE: WHITE BEAR FOOT AND ANKLE CLINIC, INC.

MEDICARE: WHITE BEAR FOOT AND ANKLE CLINIC, INC.
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
1261QP1100XPodiatric Clinic/Center923MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659777290
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE BEAR FOOT AND ANKLE CLINIC, INC.
Provider Business Mailing Address
First Line : 4653 WHITE BEAR PKWY
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-3300
Country : US
Telephone Number : 651-426-3995
Fax Number : 651-426-5626
Provider Business Practice Location Address
First Line : 4653 WHITE BEAR PKWY
Second Line :
City : WHITE BEAR LAKE
State : MN
Zip : 55110-3300
Country : US
Telephone Number : 651-426-3995
Fax Number : 651-426-5626
Authorized Official
Title or Position : DOCTOR/OWNER
Name : DR. CHRISTOPHER PHILLIPS
Credential : DPM
Telephone Number : 651-426-3995
Provider Enumeration Date : 11/10/2014
Last Update Date : 11/10/2014

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