| NPI | 1083962294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LEE WECKWERTH Credentialing Manager 612-200-8029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 631) |
| Additional Taxonomies | 152W00000X Optometrist |
| 231H00000X Audiologist | |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2021-10-07 |