Healthcare Provider Details

I. General information

NPI: 1760618011
Provider Name (Legal Business Name): NORTHLAND FOOT AND ANKLE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PKWY STE 104
SAINT PAUL MN
55116-3412
US

IV. Provider business mailing address

2270 FORD PKWY STE 104
SAINT PAUL MN
55116-3412
US

V. Phone/Fax

Practice location:
  • Phone: 651-698-8879
  • Fax: 651-698-7243
Mailing address:
  • Phone: 651-698-8879
  • Fax: 651-698-7243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number797
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number797
License Number StateMN

VIII. Authorized Official

Name: DR. SARAH P WHITTAKER
Title or Position: OWNER
Credential: DPM
Phone: 651-698-8879