Healthcare Provider Details

I. General information

NPI: 1598179269
Provider Name (Legal Business Name): COREY HOUSEPIAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 836 BOX 2670 USNMRTC SIGONELLA
FPO AE
09636
IT

IV. Provider business mailing address

PSC 836 BOX 2670
FPO AE
09636-9998
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-4333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberEL6677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: