Individual
ANDREW MOEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
844
MN
213E00000X
Podiatrist
TP-169
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073843587
—
MN
Enumeration date
01/05/2010
Last updated
12/07/2011
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