Provider Demographics
NPI:1275972259
Name:KRIEDBERG, CARLY LUCILLE (DPM)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:LUCILLE
Last Name:KRIEDBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 FRANCE AVE S STE 1100
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5924
Mailing Address - Country:US
Mailing Address - Phone:763-545-7545
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:7600 FRANCE AVE S STE 1100
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5924
Practice Address - Country:US
Practice Address - Phone:952-926-3566
Practice Address - Fax:952-929-3358
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI590100286213E00000X
MN978213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist