Provider Demographics
NPI:1003966052
Name:FELTON, TIMOTHY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:FELTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5851 DULUTH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3955
Mailing Address - Country:US
Mailing Address - Phone:763-546-1718
Mailing Address - Fax:763-546-1943
Practice Address - Street 1:5851 DULUTH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3946
Practice Address - Country:US
Practice Address - Phone:763-546-1718
Practice Address - Fax:763-546-1943
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN606213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN163936600Medicaid
MN480000328Medicare ID - Type Unspecified
MNU72782Medicare UPIN