Healthcare Provider Details

I. General information

NPI: 1669619797
Provider Name (Legal Business Name): ULTIMATE FOOT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 ST CLAUDE AVENUE
NEW ORLEANS LA
70117
US

IV. Provider business mailing address

3224 SAINT CLAUDE AVE
NEW ORLEANS LA
70117-6659
US

V. Phone/Fax

Practice location:
  • Phone: 504-945-8102
  • Fax:
Mailing address:
  • Phone: 504-945-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateLA

VIII. Authorized Official

Name: DR. MICHELLE E. G. DONALDSON-BAILEY
Title or Position: CEO/ OWNER
Credential: DPM
Phone: 504-945-8102