Provider Demographics
NPI:1912004136
Name:HOPKINS FOOT AND ANKLE CLINIC, P.A.
Entity Type:Organization
Organization Name:HOPKINS FOOT AND ANKLE CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-935-3334
Mailing Address - Street 1:29 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8087
Mailing Address - Country:US
Mailing Address - Phone:952-935-3334
Mailing Address - Fax:952-935-1935
Practice Address - Street 1:29 9TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8087
Practice Address - Country:US
Practice Address - Phone:952-935-3334
Practice Address - Fax:952-935-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN399213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN27-15056OtherMEDICA HEALTH PLAN
FM04153DOOtherBLUE SHIELD
MNT39968Medicare UPIN