Provider Demographics
NPI:1497813190
Name:MAPLEWOOD PODIATRY CLINIC
Entity Type:Organization
Organization Name:MAPLEWOOD PODIATRY CLINIC
Other - Org Name:MIDWEST FOOT & ANKLE SPECIALISTS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-439-5278
Mailing Address - Street 1:1940 GREELEY ST S
Mailing Address - Street 2:SUITE 122
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5097
Mailing Address - Country:US
Mailing Address - Phone:651-439-5278
Mailing Address - Fax:
Practice Address - Street 1:2600 39TH AVENUE NE
Practice Address - Street 2:SUITE 250
Practice Address - City:ST. ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:612-788-7274
Practice Address - Fax:612-788-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty