Healthcare Provider Details

I. General information

NPI: 1790823417
Provider Name (Legal Business Name): CENTER FOR ADVANCED FOOT & ANKLE SURGERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 ASTRA WAY
ARNOLD MO
63010-1146
US

IV. Provider business mailing address

PO BOX 771754
SAINT LOUIS MO
63177-1754
US

V. Phone/Fax

Practice location:
  • Phone: 636-296-4051
  • Fax: 636-287-9547
Mailing address:
  • Phone: 314-989-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOHN HOLTZMAN
Title or Position: PARTNER
Credential: DPM
Phone: 636-296-4051