Provider Demographics
NPI:1225144850
Name:AFFELDT, ERIC WAYNE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WAYNE
Last Name:AFFELDT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 LYNDALE AVE S STE 130
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-3398
Mailing Address - Country:US
Mailing Address - Phone:612-788-8778
Mailing Address - Fax:
Practice Address - Street 1:6600 LYNDALE AVE S STE 130
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-3398
Practice Address - Country:US
Practice Address - Phone:612-788-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN696213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist