| Organization Name: | MIDWEST FOOT AND ANKLE SPECIALISTS, LLC |
| NPI Number: | 1063704807 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRYAN L MOHR (OWNER) |
| Mailing Address: | 11901 Central Ave Ne Blaine |
| State: | MN US |
| Postal Code: | 554343911 |
| Phone Number: | 6127888778 |
| Fax Number: | 6127883408 |
| NPI Enumeration Date: | 05/12/2011 |
| NPI Last Update Date: | 05/12/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 631 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |