Provider Demographics
NPI:1356509590
Name:MICHAEL JOYCE DPM PA
Entity Type:Organization
Organization Name:MICHAEL JOYCE DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-636-5958
Mailing Address - Street 1:2680 SNELLING AVE NO
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1821
Mailing Address - Country:US
Mailing Address - Phone:651-636-5958
Mailing Address - Fax:651-636-8771
Practice Address - Street 1:2680 SNELLING AVE NO
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1821
Practice Address - Country:US
Practice Address - Phone:651-636-5958
Practice Address - Fax:651-636-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN793825000Medicaid
MN793825000Medicaid
MNU00874Medicare UPIN
480000094Medicare PIN