| NPI | 1225253305 |
|---|---|
| Former Legal Business Name | SOUTHEAST KANSAS FOOT CLINIC PA |
| Entity Type | Organization |
| Authorized Contact | CORIN Q WILDE Owner 620-231-5940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KS 1200315) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2011-05-04 |