MEDICARE: MEDICAL ARTS FOOT CLINICS, 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	213ES0131X	Foot Surgery Podiatrist	388	MN

General Provider Information

NPI Number	:	1710083837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL ARTS FOOT CLINICS, P. A.

Provider Business Mailing Address
First Line	:	3485 WILLOW LAKE BLVD
Second Line	:	SUITE 300
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-5152
Country	:	US
Telephone Number	:	651-765-8200
Fax Number	:	651-765-8201

Provider Business Practice Location Address
First Line	:	3485 WILLOW LAKE BLVD
Second Line	:	SUITE 300
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-5152
Country	:	US
Telephone Number	:	651-765-8200
Fax Number	:	651-765-8201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DALE HERBERT VANCIL
Credential	:	DPM
Telephone Number	:	651-765-8200

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	01/15/2014

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