Healthcare Provider Details

I. General information

NPI: 1669843611
Provider Name (Legal Business Name): ARCADIA FOOT & ANKLE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N STAPLEY DR SUITE 1
MESA AZ
85203-8057
US

IV. Provider business mailing address

PO BOX 20490
MESA AZ
85277-0490
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-5966
  • Fax: 480-962-9173
Mailing address:
  • Phone: 480-296-7642
  • Fax: 480-296-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0762
License Number StateAZ

VIII. Authorized Official

Name: MARK H OLSEN
Title or Position: OWNER
Credential: DPM
Phone: 714-335-2577