Provider Demographics
NPI:1831163369
Name:DONOHUE, JOHN M (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:DONOHUE
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:952-883-7469
Mailing Address - Fax:952-853-8727
Practice Address - Street 1:5100 GAMBLE DR STE 100
Practice Address - Street 2:MAIL STOP 31200A
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1588
Practice Address - Country:US
Practice Address - Phone:952-541-2500
Practice Address - Fax:952-541-2539
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-07-27
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Provider Licenses
StateLicense IDTaxonomies
MN414213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T13046Medicare UPIN
MN613725300Medicaid
T13046Medicare UPIN