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NPI Code Detail

MEDICARE: DR. MARK DENNIS HOMSTAD D.P.M.

MEDICARE: DR. MARK DENNIS HOMSTAD D.P.M.
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
1213E00000XPodiatrist395MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
186682HOOTHERMNBLUE CROSS/ BLUE SHIELD
22700556OTHERMNMEDICA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043289580
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DENNIS HOMSTAD D.P.M.
Provider Business Mailing Address
First Line : 6625 LYNDALE AVE S STE 30
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55423-2373
Country : US
Telephone Number : 612-788-8778
Fax Number : 866-691-8423
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 11/29/2021

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