Provider Demographics
NPI:1336583087
Name:ADVANCED FOOT & ANKLE CLINIC LLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-451-5950
Mailing Address - Street 1:803 E SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3112
Mailing Address - Country:US
Mailing Address - Phone:507-451-5950
Mailing Address - Fax:
Practice Address - Street 1:501 STATE ST N
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2811
Practice Address - Country:US
Practice Address - Phone:507-451-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty