# NORTH STAR PODIATRIC LAB, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962409995
- **Authorized official:** MRS. TERRI WAGNER CP (CERTIFIED PEDORTHIST)
- **Authorized official phone:** (651) 426-9388

## Contact information

- **Practice address:** 13419 FENWAY BLVD N, SUITE 101, HUGO, MN 55038-7465
- **Practice address phone:** (651) 426-9388
- **Practice address fax:** (651) 426-7450
- **Mailing address:** 13419 FENWAY BLVD N, SUITE 101, HUGO, MN 55038-7465
- **Mailing address phone:** (651) 426-9388
- **Mailing address fax:** (651) 426-7450

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 07/05/2005
- **Last updated:** 05/11/2020