Healthcare Provider Details

I. General information

NPI: 1821633967
Provider Name (Legal Business Name): RENEW FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 S POKEGAMA AVE STE 103
GRAND RAPIDS MN
55744-4289
US

IV. Provider business mailing address

8977 COVE DR NE
BEMIDJI MN
56601-6427
US

V. Phone/Fax

Practice location:
  • Phone: 218-322-6085
  • Fax: 218-293-4520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ERIC GILBERTSON
Title or Position: OWNER
Credential: DPM
Phone: 218-322-6085