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General NPI Number Information
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NPI Number | 1881409951
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Entity Type | Organization
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Legal Business Name | PROTEZ FOUNDATION
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 3510 HOPKINS PL N
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City | OAKDALE
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State | MN
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Zip | 55128-7578
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Country | US
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Telephone | 612-772-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 HOPKINS PL N
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City | OAKDALE
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State | MN
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Zip | 55128-7578
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Country | US
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Telephone | 612-772-4777
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | YAKOV GRADINAR
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Credential |
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Telephone | 612-772-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA0900X
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Taxonomy Name | Amputee Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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