Provider Demographics
NPI:1720079650
Name:LOCKNER, WILLIAM BOLIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BOLIN
Last Name:LOCKNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 517 MEDICAL ARTS BLDG.
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:612-332-7720
Mailing Address - Fax:
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 517 MEDICAL ARTS BLDG
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:612-332-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN359213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00175785OtherRAILROAD MEDICARE
MN768181046629OtherPREFERRED ONE
MNHP42871OtherHEALTHPARTNERS
MN2700017OtherMEDICA
MN86566LOOtherBLUECROSSBLUESHIELD
MN2700017OtherMEDICA