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General NPI Number Information
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NPI Number | 1174213839
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Entity Type | Organization
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Legal Business Name | LAKEVILLE FOOT AND ANKLE PRACTICE PLLC
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 10651 165TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-5670
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Country | US
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Telephone | 612-670-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 10651 165TH ST W
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City | LAKEVILLE
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State | MN
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Zip | 55044-5670
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Country | US
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Telephone | 612-670-0920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARCUS JAMES DUVAL
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Credential | DPM
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Telephone | 612-670-0920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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