MEDICARE: ORTHOPEDIC ASSOCIATES OF DULUTH, P.A.

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	174400000X	Specialist	101	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000018080	OTHER	WI	MEDICARE WPS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	78040OR	OTHER	MN	BLUE CROSS
3	A001	OTHER		TRICARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225033715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC ASSOCIATES OF DULUTH, P.A.

Provider Business Mailing Address
First Line	:	1000 E 1ST ST
Second Line	:	STE 404
City	:	DULUTH
State	:	MN
Zip	:	55805-2297
Country	:	US
Telephone Number	:	218-722-9753
Fax Number	:	218-722-6515

Provider Business Practice Location Address
First Line	:	1000 E 1ST ST
Second Line	:	STE 404
City	:	DULUTH
State	:	MN
Zip	:	55805-2297
Country	:	US
Telephone Number	:	218-722-9753
Fax Number	:	218-722-6515

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JUNE WALLER
Credential	:
Telephone Number	:	218-625-1886

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/23/2016

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Directions to “ORTHOPEDIC ASSOCIATES OF DULUTH, P.A. ” Practice Location

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