Organization
NORTH STAR PODIATRIC LABORATORIES INC.
Active
Parent organization
1962409995
Organization subpart
Yes
Provider details
NPI number
Legal business name
1962409995
Authorized official
MRS. TERESA ANN WAGNER CERTIFIED PEDORTHIST (PRESIDENT)
(651) 426-9388
Entity
Organization
Contact information
Practice address
7400 LYNDALE AVE S STE 160, RICHFIELD, MN 55423-4142
(651) 353-5845
(612) 224-9457
Mailing address
13419 FENWAY BLVD N STE 101, HUGO, MN 55038-7466
(651) 426-9388
(651) 426-7450
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/13/2017
Last updated
10/25/2017
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