Individual
DR. MARK DENNIS HOMSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6625 LYNDALE AVE S STE 105, RICHFIELD, MN 55423-2673
(612) 788-8778
Mailing address
6625 LYNDALE AVE S STE 30, MINNEAPOLIS, MN 55423-2373
(612) 788-8778
(866) 691-8423
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
395
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2700556
MEDICA
MN
05
—
473525100
—
MN
01
—
86682HO
BLUE CROSS/ BLUE SHIELD
MN
Enumeration date
03/16/2006
Last updated
11/29/2021
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