Provider Demographics
NPI:1962838706
Name:ON-SITE PODIATRY, INC.
Entity Type:Organization
Organization Name:ON-SITE PODIATRY, INC.
Other - Org Name:PINNACLE FOOT AND ANKLE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINCHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:952-929-2068
Mailing Address - Street 1:5201 EDEN AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-2316
Mailing Address - Country:US
Mailing Address - Phone:952-926-3566
Mailing Address - Fax:952-929-2067
Practice Address - Street 1:12940 HARRIET AVE S
Practice Address - Street 2:STE 230
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2680
Practice Address - Country:US
Practice Address - Phone:952-926-3566
Practice Address - Fax:952-426-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN750213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty