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General NPI Number Information
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NPI Number | 1285968867
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Entity Type | Organization
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Legal Business Name | MIDWEST FOOT & ANKLE LLC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 8240 NAAB RD SUITE 360
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1987
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Country | US
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Telephone | 317-297-3338
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Fax | 317-297-9997
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Provider Business Mailing Address
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Address Line | 3850 SHORE DR SUITE 301
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-4693
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Country | US
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Telephone | 317-297-3338
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Fax | 317-297-9997
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIRK S HOLSTON
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Credential | D.P.M.
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Telephone | 317-297-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 070000768A
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License Number State | IN
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