MEDICARE: DR. ALEXANDER NICK WOROBEL 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
1	213E00000X	Podiatrist	351	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	126577	OTHER	MN	UCARE MN
2	HP11744	OTHER	MN	HEALTH PARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	077R9WO	OTHER	MN	BCBS MN

General Provider Information

NPI Number	:	1174540736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER NICK WOROBEL DPM

Provider Business Mailing Address
First Line	:	4653 WHITE BEAR PKWY
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3300
Country	:	US
Telephone Number	:	651-426-3995
Fax Number	:	651-426-5626

Provider Business Practice Location Address
First Line	:	4653 WHITE BEAR PKWY
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3300
Country	:	US
Telephone Number	:	651-426-3995
Fax Number	:	651-426-5626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	12/18/2007

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