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General NPI Number Information
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NPI Number | 1275534885
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT AND ANKLE CLINIC, PA
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 3790 117TH LN NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2666
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Country | US
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Telephone | 763-421-7300
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Fax | 763-421-3337
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Provider Business Mailing Address
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Address Line | 3790 117TH LN NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2666
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Country | US
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Telephone | 763-421-7300
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Fax | 763-421-3337
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CRISTY ANN NOREM
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Credential |
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Telephone | 763-421-7300
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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 | 1924011
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License Number State | MN
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