| NPI | 1801602636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ELIZABETH DEITHLOFF Dpm/Owner 505-395-9575 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2024-12-06 |
| Last Update Date | 2024-12-06 |