MEDICARE: MIDWEST FOOT & ANKLE SPECIALISTS, LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1467627125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST FOOT & ANKLE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	7430 80TH ST S
Second Line	:	SUITE 104
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3035
Country	:	US
Telephone Number	:	651-459-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 80TH ST S
Second Line	:	SUITE 104
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-3035
Country	:	US
Telephone Number	:	651-459-9171
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRYAN MOHR
Credential	:	DPM
Telephone Number	:	651-459-9171

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	02/02/2011

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