MEDICARE: WHITE BEAR FOOT CLINIC INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	121124	OTHER	MN	HEALTH PARTNERS
2	J890	OTHER	MN	UCARE MN PAYEE ID
3	077R8WH	OTHER	MN	BCBS MN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891712451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITE BEAR FOOT CLINIC INC

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	:	OWNER
Name	:	DR. ALEXANDER N WOROBEL
Credential	:	DPM
Telephone Number	:	651-426-3995

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

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Directions to “WHITE BEAR FOOT CLINIC INC ” Practice Location

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