Organization
ORTHOPEDIC ASSOCIATES OF DULUTH, P.A.
Active
Other names
Orthopaedic Associates of Duluth, P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
JUNE WALLER (OFFICE MANAGER)
(218) 625-1886
Entity
Organization
Contact information
Practice address
1000 E 1ST ST, STE 404, DULUTH, MN 55805-2297
(218) 722-9753
(218) 722-6515
Mailing address
1000 E 1ST ST, STE 404, DULUTH, MN 55805-2297
(218) 722-9753
(218) 722-6515
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
101
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000018080
MEDICARE WPS
WI
05
—
177808100
—
MN
01
—
78040OR
BLUE CROSS
MN
01
—
A001
TRICARE
—
Enumeration date
06/20/2005
Last updated
02/23/2016
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