=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891712451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WHITE BEAR FOOT CLINIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 12/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4653 WHITE BEAR PKWY
-----------------------------------------------------
City | WHITE BEAR LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55110-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-426-3995
-----------------------------------------------------
Fax | 651-426-5626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4653 WHITE BEAR PKWY
-----------------------------------------------------
City | WHITE BEAR LAKE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55110-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-426-3995
-----------------------------------------------------
Fax | 651-426-5626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALEXANDER N WOROBEL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 651-426-3995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------