MEDICARE: APACHE FOOT & ANKLE SPECIALIST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1275876542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APACHE FOOT & ANKLE SPECIALIST LLC

Provider Business Mailing Address
First Line	:	8530 W SUNSET RD STE 345
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2247
Country	:	US
Telephone Number	:	702-362-2622
Fax Number	:	702-362-0422

Provider Business Practice Location Address
First Line	:	8530 W SUNSET RD STE 345
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2247
Country	:	US
Telephone Number	:	702-362-2622
Fax Number	:	702-362-0422

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	LEE A WITTENBERG
Credential	:
Telephone Number	:	702-362-2622

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	12/15/2022

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