Homstad, Mark Dennis

Homstad, Mark Dennis is an individual health care provider with primary practice located at 6625 Lyndale Ave S Ste 105 , Richfield MN 55423-2673. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Homstad, Mark Dennis can be contacted via phone (612) 788-8778.

Contact Information

Primary practice address
6625 Lyndale Ave S Ste 105 Richfield MN 55423-2673
Phone: (612) 788-8778
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 395 Minnesota

Profile Details

NPI number 1043289580
LBN Legal business name Homstad, Mark Dennis
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2006
Last updated Nov 29th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043289580 NPPES
Minnesota Other 86682HO BLUE CROSS/ BLUE SHIELD
Minnesota Other 2700556 BLUE CROSS/ BLUE SHIELD
Minnesota MEDICAID 473525100 BLUE CROSS/ BLUE SHIELD

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