=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780871848
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER WEIS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2007
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6344 PENN AVE S
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
Fax | 612-866-5875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6344 PENN AVE S
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
Fax | 612-866-5875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINIC OWNER
-----------------------------------------------------
Name | DR. CHRISTOPHER JOHN WEIS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 612-866-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 362
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------