Healthcare Provider Details

I. General information

NPI: 1023086113
Provider Name (Legal Business Name): ELITE FOOT AND ANKLE SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E MCDOWELL RD SUITE A
PHOENIX AZ
85006-2625
US

IV. Provider business mailing address

1002 E MCDOWELL RD SUITE A
PHOENIX AZ
85006-2625
US

V. Phone/Fax

Practice location:
  • Phone: 602-262-2663
  • Fax: 602-258-3008
Mailing address:
  • Phone: 602-262-2663
  • Fax: 602-258-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00571
License Number StateAZ

VIII. Authorized Official

Name: DR. BRANDON J KIM
Title or Position: OWNER
Credential: DPM
Phone: 602-995-1169