Organization
ACTIVE FEET LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY LEE WHITE DPM (OWNER)
(612) 240-6028
Entity
Organization
Contact information
Practice address
7250 FRANCE AVE S, SUITE 415, EDINA, MN 55435-4305
(952) 926-3566
(952) 929-3358
Mailing address
7250 FRANCE AVE S, SUITE 415, EDINA, MN 55435-4305
(952) 926-3566
(952) 929-3358
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
595
MN
Other
Enumeration date
01/21/2011
Last updated
02/25/2011
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