Healthcare Provider Details

I. General information

NPI: 1790183028
Provider Name (Legal Business Name): WEILAND FOOT AND ANKLE CLINIC, PROF. L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24237 474TH AVE
DELL RAPIDS SD
57022-6120
US

IV. Provider business mailing address

24237 474TH AVE
DELL RAPIDS SD
57022-6120
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-5941
  • Fax: 605-205-7612
Mailing address:
  • Phone: 605-212-5941
  • Fax: 605-205-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number179
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON ANDREW WEILAND
Title or Position: PRESIDENT/CEO
Credential: DPM
Phone: 605-212-5941