Provider Demographics
NPI:1780171165
Name:FOOT & ANKLE CLINIC, LLC
Entity type:Organization
Organization Name:FOOT & ANKLE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PANETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:507-282-1053
Mailing Address - Street 1:2768 SUPERIOR DR NW STE B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-8394
Mailing Address - Country:US
Mailing Address - Phone:507-282-1053
Mailing Address - Fax:507-282-1384
Practice Address - Street 1:2768 SUPERIOR DR NW STE B
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-8394
Practice Address - Country:US
Practice Address - Phone:507-282-1053
Practice Address - Fax:507-282-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN479213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty