Provider Demographics
NPI:1144700220
Name:MIDWEST FOOT AND ANKLE CENTER PC
Entity type:Organization
Organization Name:MIDWEST FOOT AND ANKLE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-570-0654
Mailing Address - Street 1:2716 29TH AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-8805
Mailing Address - Country:US
Mailing Address - Phone:515-571-5217
Mailing Address - Fax:
Practice Address - Street 1:804 KENYON RD STE 310
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5746
Practice Address - Country:US
Practice Address - Phone:515-570-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA587261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric