Healthcare Provider Details

I. General information

NPI: 1659531291
Provider Name (Legal Business Name): FOOT AND ANKLE CARE CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 UNIVERSITY AVE W STE 126
SAINT PAUL MN
55103-3907
US

IV. Provider business mailing address

225 UNIVERSITY AVE W STE 126
SAINT PAUL MN
55103-3907
US

V. Phone/Fax

Practice location:
  • Phone: 651-290-2000
  • Fax: 651-290-2000
Mailing address:
  • Phone: 651-290-2000
  • Fax: 651-290-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number656
License Number StateMN

VIII. Authorized Official

Name: JAMES N VANG
Title or Position: OWNER
Credential: DPM
Phone: 651-290-2000