Healthcare Provider Details

I. General information

NPI: 1891982914
Provider Name (Legal Business Name): CASA GRANDE FOOT & ANKLE SPEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 E COTTONWOOD LN
CASA GRANDE AZ
85222-2023
US

IV. Provider business mailing address

PO BOX 11083
CASA GRANDE AZ
85230-1083
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3400
  • Fax: 520-836-2425
Mailing address:
  • Phone: 520-836-3400
  • Fax: 520-836-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ADAM K LU
Title or Position: OWNER
Credential: DPM
Phone: 520-836-3400