Healthcare Provider Details

I. General information

NPI: 1245527258
Provider Name (Legal Business Name): IN STEP PODIATRY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 MITCHELLVILLE RD SUITE 105
BOWIE MD
20716-1385
US

IV. Provider business mailing address

PO BOX 683
BOWIE MD
20718-0683
US

V. Phone/Fax

Practice location:
  • Phone: 301-430-0337
  • Fax: 301-542-0086
Mailing address:
  • Phone: 301-430-0311
  • Fax: 301-542-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: QUEEN MBANUZUE
Title or Position: OWNER
Credential:
Phone: 301-430-0337