Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 383 | MN |
Y | 222Z00000X | Podiatrist | 383 | MN |
NPI | 1023082211 |
---|---|
Provider Name | Dr. Craig J Ficks |
First Address | Edina, MN 55435-5924 |
Second Address | Edina, MN 55435-5924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
683325000 | (05) | MN |
T39676 | (02) | MN |