Organization
MIDWEST FOOT AND ANKLE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NITIE I SROA (DPM)
(419) 799-1180
Entity
Organization
Contact information
Practice address
121 WESTFIELD DR, ARCHBOLD, OH 43502-1056
(419) 799-1180
Mailing address
208 COLUMBUS ST STE 200, HICKSVILLE, OH 43526-1250
(419) 799-1180
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300051280
—
IN
Enumeration date
11/11/2021
Last updated
11/12/2021
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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