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General NPI Number Information
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NPI Number | 1023231693
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Entity Type | Organization
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Legal Business Name | MIDWEST FOOT AND ANKLE SPECIALISTS PC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 3740 E LAKE CTR
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City | QUINCY
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State | IL
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Zip | 62305-5805
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Country | US
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Telephone | 217-223-3668
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Fax | 217-223-3412
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Provider Business Mailing Address
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Address Line | 3740 E LAKE CTR
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City | QUINCY
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State | IL
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Zip | 62305-5805
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Country | US
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Telephone | 217-223-3668
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Fax | 217-223-3412
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOUGLAS JOHN FREEL
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Credential | DPM
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Telephone | 217-223-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 060228083
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License Number State | IL
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