Provider Demographics
NPI:1194890954
Name:JOYCE, MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:JOYCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 SNELLING AVE NO
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1821
Mailing Address - Country:US
Mailing Address - Phone:651-636-5958
Mailing Address - Fax:651-636-8771
Practice Address - Street 1:2680 SNELLING AVE NO
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1821
Practice Address - Country:US
Practice Address - Phone:651-636-5958
Practice Address - Fax:651-636-8771
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN793825000Medicaid
MN0465140001Medicare NSC
MNU00874Medicare UPIN
480000094Medicare PIN