Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 562 | MN |
Y | 222Z00000X | Podiatrist | 562 | MN |
NPI | 1013977644 |
---|---|
Provider Name | Todd Arnold Shea |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55402-2610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 23/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
965725800 | (05) | MN |
U63204 | (02) |