Provider Demographics
NPI:1255541447
Name:FOOT AND ANKLE CENTER PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:641-787-9500
Mailing Address - Street 1:209 N 2ND AVE W
Mailing Address - Street 2:PO BOX 901
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3033
Mailing Address - Country:US
Mailing Address - Phone:641-787-9500
Mailing Address - Fax:
Practice Address - Street 1:209 N 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3033
Practice Address - Country:US
Practice Address - Phone:641-787-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00751213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherEIN #
IAU91854Medicare UPIN
IA=========OtherEIN #
IAI16088Medicare PIN