Provider Demographics
NPI:1174540736
Name:WOROBEL, ALEXANDER NICK (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:NICK
Last Name:WOROBEL
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 1:4653 WHITE BEAR PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3300
Mailing Address - Country:US
Mailing Address - Phone:651-426-3995
Mailing Address - Fax:651-426-5626
Practice Address - Street 1:4653 WHITE BEAR PKWY
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3300
Practice Address - Country:US
Practice Address - Phone:651-426-3995
Practice Address - Fax:651-426-5626
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN351213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126577OtherUCARE MN
MNHP11744OtherHEALTH PARTNERS
WI43240000Medicaid
MN077R9WOOtherBCBS MN
MN077R9WOOtherBCBS MN
MN126577OtherUCARE MN
WI43240000Medicaid