Provider Demographics
NPI:1063782472
Name:M & D ENTERPRISES PC
Entity type:Organization
Organization Name:M & D ENTERPRISES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:605-348-6180
Mailing Address - Street 1:3641 STURGIS RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0321
Mailing Address - Country:US
Mailing Address - Phone:605-348-6180
Mailing Address - Fax:605-348-9121
Practice Address - Street 1:3641 STURGIS RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0321
Practice Address - Country:US
Practice Address - Phone:605-348-6180
Practice Address - Fax:605-348-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-03
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD142261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4563 SOtherMEDICARE IDENTIFICATION #