MEDICARE: CHRISTOPHER WEIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	362	MN

General Provider Information

NPI Number	:	1780871848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTOPHER WEIS

Provider Business Mailing Address
First Line	:	6344 PENN AVE S
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-1139
Country	:	US
Telephone Number	:	612-866-3601
Fax Number	:	612-866-5875

Provider Business Practice Location Address
First Line	:	6344 PENN AVE S
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-1139
Country	:	US
Telephone Number	:	612-866-3601
Fax Number	:	612-866-5875

Authorized Official
Title or Position	:	CLINIC OWNER
Name	:	DR. CHRISTOPHER JOHN WEIS
Credential	:	DPM
Telephone Number	:	612-866-3601

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	04/22/2008

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