Provider Demographics
NPI:1205954278
Name:FOOT CLINICS LTD, P.A.
Entity type:Organization
Organization Name:FOOT CLINICS LTD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-698-8879
Mailing Address - Street 1:2221 FORD PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1800
Mailing Address - Country:US
Mailing Address - Phone:651-698-8879
Mailing Address - Fax:651-698-7243
Practice Address - Street 1:2221 FORD PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1800
Practice Address - Country:US
Practice Address - Phone:651-698-8879
Practice Address - Fax:651-698-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN449213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59599JUOtherBCBS
MN59599JUOtherBCBS
MNC01570Medicare PIN