MEDICARE: WEILAND FOOT AND ANKLE CLINIC, PROF. L.L.C.

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
2	213E00000X	Podiatrist	179	SD

General Provider Information

NPI Number	:	1790183028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEILAND FOOT AND ANKLE CLINIC, PROF. L.L.C.

Provider Business Mailing Address
First Line	:	24237 474TH AVE
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-6120
Country	:	US
Telephone Number	:	605-212-5941
Fax Number	:	605-205-7612

Provider Business Practice Location Address
First Line	:	24237 474TH AVE
Second Line	:
City	:	DELL RAPIDS
State	:	SD
Zip	:	57022-6120
Country	:	US
Telephone Number	:	605-212-5941
Fax Number	:	605-205-7612

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JASON ANDREW WEILAND
Credential	:	DPM
Telephone Number	:	605-212-5941

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	05/08/2023

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