Organization
MIDWEST FOOT AND ANKLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIRK S HOLSTON D.P.M. (OWNER)
(317) 297-3338
Entity
Organization
Contact information
Practice address
3850 SHORE DR, SUITE 301, INDIANAPOLIS, IN 46254-5621
(317) 297-3338
Mailing address
3850 SHORE DR, SUITE 301, INDIANAPOLIS, IN 46254-5621
(317) 297-3338
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
070000768A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000364508
ANTHEM BCBS
IN
01
—
0005497063
AETNA
IN
05
—
200527610A
—
IN
05
—
200527610B
—
IN
Enumeration date
09/15/2006
Last updated
01/08/2010
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