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General NPI Number Information
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NPI Number | 1750720876
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Entity Type | Individual
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Provider Name | TODD AARON PEABODY DPM
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Gender | Male
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 09/12/2018
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Provider Practice Location Address
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Address Line | 6600 LYNDALE AVE S STE 130
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City | RICHFIELD
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State | MN
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Zip | 55423
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Country | US
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Telephone | 612-788-8778
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 LYNDALE AVE S STE 130
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City | RICHFIELD
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State | MN
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Zip | 55423-3398
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Country | US
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Telephone | 612-788-8778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1002
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License Number State | MN
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