Healthcare Provider Details

I. General information

NPI: 1720790405
Provider Name (Legal Business Name): FAMILY FOOT CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 45TH AVE
MUNSTER IN
46321
US

IV. Provider business mailing address

2308 ROOSEVELT ROAD
VALPARAISO IN
46383
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-9588
  • Fax:
Mailing address:
  • Phone: 219-464-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. REEM MOHAMMAD
Title or Position: PODIATRIST
Credential: DPM
Phone: 219-464-9588