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General NPI Number Information
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NPI Number | 1912004136
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Entity Type | Organization
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Legal Business Name | HOPKINS FOOT AND ANKLE CLINIC, P.A.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 29 9TH AVE N
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City | HOPKINS
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State | MN
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Zip | 55343-8087
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Country | US
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Telephone | 952-935-3334
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Fax | 952-935-1935
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Provider Business Mailing Address
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Address Line | 29 9TH AVE N
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City | HOPKINS
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State | MN
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Zip | 55343-8087
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Country | US
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Telephone | 952-935-3334
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Fax | 952-935-1935
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN DOMS
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Credential | D.P.M.
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Telephone | 952-935-3334
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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 | 399
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License Number State | MN
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