=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669647400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED PODIATRISTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2008
-----------------------------------------------------
Last Update Date | 02/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6344 PENN AVE S
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
Fax | 612-866-5875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6344 PENN AVE S
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
Fax | 612-866-5875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN J ALTMAN
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------