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General NPI Number Information
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NPI Number | 1780171165
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE CLINIC, LLC
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Dates
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Enumeration Date | 04/20/2018
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Last Update Date | 04/20/2018
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Provider Practice Location Address
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Address Line | 2768 SUPERIOR DR NW STE B
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City | ROCHESTER
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State | MN
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Zip | 55901-8394
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Country | US
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Telephone | 507-282-1053
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Fax | 507-282-1384
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Provider Business Mailing Address
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Address Line | 2768 SUPERIOR DR NW STE B
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City | ROCHESTER
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State | MN
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Zip | 55901-8394
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Country | US
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Telephone | 507-282-1053
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Fax | 507-282-1384
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN EDWARD PANETTA
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Credential | DPM
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Telephone | 507-282-1053
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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 | 479
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License Number State | MN
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