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NPI Code Detail

MEDICARE: MR. BRYAN MOHR DPM

MEDICARE:  MR. BRYAN  MOHR  DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist1164-25WI
2213E00000XPodiatrist631MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
154B22MOOTHERMNBLUE CROSS
2HP30542OTHERMNHEALTH PARTNERS
3124307OTHERMNUCARE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043215528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN MOHR DPM
Provider Business Mailing Address
First Line : 6625 LYNDALE AVE S STE 300
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2491
Country : US
Telephone Number : 612-788-8778
Fax Number : 612-869-3473
Provider Business Practice Location Address
First Line : 6625 LYNDALE AVE S STE 105
Second Line :
City : RICHFIELD
State : MN
Zip : 55423-2673
Country : US
Telephone Number : 612-788-8778
Fax Number : 612-869-3473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 04/29/2020

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Directions to “ MR. BRYAN MOHR DPM” Practice Location

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