Provider Demographics
NPI:1053438648
Name:ADVANCED FOOT CARE CLINIC,LTD
Entity type:Organization
Organization Name:ADVANCED FOOT CARE CLINIC,LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:763-550-1013
Mailing Address - Street 1:825 NICOLLET MALL
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-2606
Mailing Address - Country:US
Mailing Address - Phone:763-550-1013
Mailing Address - Fax:763-550-0615
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:SUITE 601
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2606
Practice Address - Country:US
Practice Address - Phone:763-550-1013
Practice Address - Fax:763-550-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN507213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4724190001Medicare NSC