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General NPI Number Information
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NPI Number | 1801836234
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE CLINICS PA
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/02/2008
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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 | 218-365-2570
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Fax | 218-365-2570
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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 | 218-365-2570
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Fax | 218-365-2570
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY CRAIG PELLERSELS
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Credential | DPM
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Telephone | 651-457-4665
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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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