MEDICARE: ADVANCED FOOT AND ANKLE ACADEMY

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	:	1669160859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FOOT AND ANKLE ACADEMY

Provider Business Mailing Address
First Line	:	5317 ITASKA ST UNIT 2F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2921
Country	:	US
Telephone Number	:	646-251-8364
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 ITASKA ST UNIT 2F
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-2921
Country	:	US
Telephone Number	:	646-251-8364
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMUR DAVYDOV
Credential	:	DPM
Telephone Number	:	646-251-8364

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	06/28/2023

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Directions to “ADVANCED FOOT AND ANKLE ACADEMY ” Practice Location

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