| NPI | 1871192716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW T DEWITT Owner 765-729-1083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2021-02-04 |