Healthcare Provider Details

I. General information

NPI: 1366853715
Provider Name (Legal Business Name): ABIGAIL SMITH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 04/10/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 FRANCE AVE S STE 1100
EDINA MN
55435-5936
US

IV. Provider business mailing address

100 CROSSING BLVD STE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone: 888-964-6681
  • Fax: 888-662-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1082
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: