Provider Demographics
NPI:1134155260
Name:SZOPA, TIMOTHY J (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:SZOPA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:407 W 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2304
Practice Address - Country:US
Practice Address - Phone:612-798-8800
Practice Address - Fax:612-798-8816
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN702213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN34829700Medicaid
MN480000788Medicare PIN
U91936Medicare UPIN