MEDICARE: NORTHLAND FOOT AND ANKLE SPECIALISTS, P.C.

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	332BC3200X	Customized Equipment (DME)	797	MN
2	213ES0103X	Foot & Ankle Surgery Podiatrist	797	MN

General Provider Information

NPI Number	:	1760618011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHLAND FOOT AND ANKLE SPECIALISTS, P.C.

Provider Business Mailing Address
First Line	:	2270 FORD PKWY STE 104
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-698-8879
Fax Number	:	651-698-7243

Provider Business Practice Location Address
First Line	:	2270 FORD PKWY STE 104
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-3412
Country	:	US
Telephone Number	:	651-698-8879
Fax Number	:	651-698-7243

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SARAH P WHITTAKER
Credential	:	DPM
Telephone Number	:	651-698-8879

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	05/20/2024

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