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General NPI Number Information
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NPI Number | 1790730380
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Entity Type | Individual
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Provider Name | JEFFREY CRAIG PELLERSELS DPM
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Gender | Male
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 563 BIELENBERG DR SUITE 150
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City | WOODBURY
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State | MN
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Zip | 55125-4425
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Country | US
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Telephone | 651-457-4665
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Fax | 651-457-3115
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Provider Business Mailing Address
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Address Line | 563 BIELENBERG DR SUITE 150
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City | WOODBURY
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State | MN
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Zip | 55125-4425
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Country | US
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Telephone | 651-457-4665
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Fax | 651-457-3115
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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 | 473
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 668-025
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 473
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 668-025
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License Number State | WI
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