MEDICARE: M & D ENTERPRISES PC

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	261QP1100X	Podiatric Clinic/Center	142	SD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4563 S	OTHER	SD	MEDICARE IDENTIFICATION #

General Provider Information

NPI Number	:	1063782472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M & D ENTERPRISES PC

Provider Business Mailing Address
First Line	:	3641 STURGIS RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0321
Country	:	US
Telephone Number	:	605-348-6180
Fax Number	:	605-348-9121

Provider Business Practice Location Address
First Line	:	3641 STURGIS RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0321
Country	:	US
Telephone Number	:	605-348-6180
Fax Number	:	605-348-9121

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAN PHILIP CONRAD
Credential	:	DPM
Telephone Number	:	605-348-6180

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	01/26/2012

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Directions to “M & D ENTERPRISES PC ” Practice Location

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