Provider Demographics
NPI:1033156906
Name:ADVANCED FOOT & ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-451-5950
Mailing Address - Street 1:803 E SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3112
Mailing Address - Country:US
Mailing Address - Phone:507-451-5950
Mailing Address - Fax:507-451-5514
Practice Address - Street 1:803 E SCHOOL ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3112
Practice Address - Country:US
Practice Address - Phone:507-451-5950
Practice Address - Fax:507-451-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN114357D102OtherUCARE
MN767042700Medicaid
MN6B282ROOtherBLUE CROSS BLUE SHILED
MN28485OtherHEALTHPARTNERS
C07768OtherMEDICARE
MN0835570001Medicare NSC
MN6B282ROOtherBLUE CROSS BLUE SHILED
C07768OtherMEDICARE
489000191Medicare PIN
480000466Medicare PIN
U79719Medicare UPIN