Provider Demographics
NPI:1760618011
Name:NORTHLAND FOOT AND ANKLE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:NORTHLAND FOOT AND ANKLE SPECIALISTS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:651-698-8879
Mailing Address - Street 1:2270 FORD PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3412
Mailing Address - Country:US
Mailing Address - Phone:651-698-8879
Mailing Address - Fax:651-698-7243
Practice Address - Street 1:2270 FORD PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-3412
Practice Address - Country:US
Practice Address - Phone:651-698-8879
Practice Address - Fax:651-698-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN797332BC3200X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6269050001Medicare NSC
MNC05293Medicare PIN