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General NPI Number Information
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NPI Number | 1053392027
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Entity Type | Organization
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Legal Business Name | DOWNTOWN SKYWAY FOOT SPECIALISTS INC
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 08/10/2012
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Provider Practice Location Address
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Address Line | 825 NICOLLET MALL SUITE 517 MEDICAL ARTS BLDG
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2606
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Country | US
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Telephone | 612-332-7720
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Fax | 612-333-8981
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Provider Business Mailing Address
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Address Line | 825 NICOLLET MALL SUITE 517 MEDICAL ARTS BLDG
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City | MINNEAPOLIS
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State | MN
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Zip | 55402-2606
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Country | US
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Telephone | 612-332-7720
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Fax | 612-333-8981
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM BOLIN LOCKNER
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Credential | DPM
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Telephone | 612-332-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 359
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License Number State | MN
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