Healthcare Provider Details

I. General information

NPI: 1881409951
Provider Name (Legal Business Name): PROTEZ FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2025
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 HOPKINS PL N
OAKDALE MN
55128-7578
US

IV. Provider business mailing address

3510 HOPKINS PL N
OAKDALE MN
55128-7578
US

V. Phone/Fax

Practice location:
  • Phone: 612-772-4777
  • Fax:
Mailing address:
  • Phone: 612-772-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0900X
TaxonomyAmputee Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: YAKOV GRADINAR
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 612-772-4777