Healthcare Provider Details

I. General information

NPI: 1760621924
Provider Name (Legal Business Name): ACTIVE FOOT SOLUTIONS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10464 METCALF AVE
OVERLAND PARK KS
66212-1806
US

IV. Provider business mailing address

10318 WALMER ST
OVERLAND PARK KS
66212-1741
US

V. Phone/Fax

Practice location:
  • Phone: 913-649-6677
  • Fax: 913-649-6679
Mailing address:
  • Phone: 913-649-6677
  • Fax: 913-649-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number12-00313
License Number StateKS

VIII. Authorized Official

Name: DR. AMBER STEINFORD BEISIEGEL
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 913-649-6677