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Individual

AMANDA MCGUIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPM

Contact information

Practice address
6625 LYNDALE AVE S STE 105, RICHFIELD, MN 55423-2673
(612) 788-8778
(612) 869-3473
Mailing address
6625 LYNDALE AVE S STE 300, RICHFIELD, MN 55423-2491
(612) 788-8778
(612) 869-3473

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1084
MN
213ES0103X
Foot & Ankle Surgery Podiatrist
135000923
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016005791
IL
01
1084
PROFESSIONAL LICENSE
MN
05
1124470745
MN
01
135000923
PROFESSIONAL LICENSE
IL
Enumeration date
07/07/2016
Last updated
09/13/2021
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