Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | CPO 1904 | MN |
Y | 222Z00000X | Podiatrist | CPO 1904 | MN |
N | 224P00000X | Prosthetist | CPO 1904 | MN |
NPI | 1467673715 |
---|---|
Provider Name | Mr. Todd Michael Westlake |
First Address | Rogers, MN 55374-8740 |
Second Address | Minneapolis, MN 55454-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 26/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077842 | FAIRVIEW HEATH SERVICES # (01) | MN |