Provider Demographics
NPI:1912916388
Name:NATWICK, JAMES ROLF (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROLF
Last Name:NATWICK
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 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:4000 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-2968
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-782-8100
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN622213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2711916OtherMEDICA
MN7782045OtherAETNA
MN847607OtherAMERICA'S PPO
MNHP28397OtherHEALTHPARTNERS
MN123677OtherUCARE MN
MN1020568OtherPREFERRED ONE
MN086220700Medicaid
MN74D09NAOtherBCBS OF MN