Organization Name: | MID DAKOTA PODIATRY |
NPI Number: | 1144455858 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JESSE D OLSON (OWNER) |
Mailing Address: | 127 W Dakota Ave Pierre |
State: | SD US |
Postal Code: | 575014501 |
Phone Number: | 6059956200 |
Fax Number: | 6059951910 |
NPI Enumeration Date: | 05/26/2009 |
NPI Last Update Date: | 05/26/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 164 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |