Healthcare Provider Details

I. General information

NPI: 1124133764
Provider Name (Legal Business Name): JOHN C FOLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 CONCORDIA AVE SUITE 201
SAINT PAUL MN
55104-4548
US

IV. Provider business mailing address

2854 HIGHWAY 55 SUITE 130
EAGAN MN
55121-2156
US

V. Phone/Fax

Practice location:
  • Phone: 651-287-2020
  • Fax: 651-294-2020
Mailing address:
  • Phone: 651-842-3328
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number43920
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: