Healthcare Provider Details

I. General information

NPI: 1154600880
Provider Name (Legal Business Name): ANKLES & FEET PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 02/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 HIGHWAY 280 STE 124
BIRMINGHAM AL
35242-6585
US

IV. Provider business mailing address

PO BOX 382257
BIRMINGHAM AL
35238-2257
US

V. Phone/Fax

Practice location:
  • Phone: 205-980-2005
  • Fax: 205-981-4513
Mailing address:
  • Phone: 334-531-8771
  • Fax: 334-981-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001049
License Number StateGA

VIII. Authorized Official

Name: LISA A PANTHEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 334-531-8771