Organization
MIDWEST FOOT AND ANKLE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NITIE I SROA DPM (OWNER)
(419) 799-1180
Entity
Organization
Contact information
Practice address
1035 W WAYNE ST, PAULDING, OH 45879-1544
(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
—
300058920
—
IN
Enumeration date
02/22/2022
Last updated
02/22/2022
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