Provider Demographics
NPI:1053392027
Name:DOWNTOWN SKYWAY FOOT SPECIALISTS INC
Entity type:Organization
Organization Name:DOWNTOWN SKYWAY FOOT SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BOLIN
Authorized Official - Last Name:LOCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:612-332-7720
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:612-333-8981
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:612-333-8981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN359213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN102943OtherHEALTHPARTNERS
MN768181046629OtherPREFERRED ONE
MN062096300Medicaid
MN165613OtherUCARE
MN2728357OtherMEDICA
MN535942OtherAMERICA'S PPO
MN10074LOOtherBLUECROSSBLUESHIELD
MNDC5459OtherRAILROAD MEDICARE
MN2728357OtherMEDICA
MN5254910001Medicare NSC