Diabetic Shoe Source

NPI 1003960147 - Durable Medical Equipment & Medical Supplies - 332B00000X

NPI Details
NPI 1003960147
Enumeration Date 01/23/2007
Last Updated 03/10/2015
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name MARK MARK
Position PRESIDENT
Phone (763) 757-8086
Fax (763) 862-4797
Practice Location
7362 UNIVERSITY AVE NE
SUITE 306
FRIDLEY MN, 55432-3142, US
Phone (763) 757-8086
Fax (763) 862-4797
Business Location
7362 UNIVERSITY AVE NE
SUITE 306
FRIDLEY MN, 55432-3142, US
Phone (763) 757-8086
Fax (763) 862-4797
Toxanomy
Taxonomy Code 332B00000X
License State
License Number
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According to our database, Diabetic Shoe Source NPI is 1003960147, taxonomy code is 332B00000X Diabetic Shoe Source physically located at 7362 University Ave Ne, Fridley MN, 55432-3142. NPI Number 1033115704 has the healthcare provider type.

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1003960147 NPI number is provided on an as is basis without warranty of any kind. 1003960147 is maintained by the National Plan & Provider Enumeration System. The contents of Diabetic Shoe Source are for informational purposes only.