Healthcare Provider Details

I. General information

NPI: 1346029105
Provider Name (Legal Business Name): A FOOT DOCTOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 THORNLEA CT
BALLWIN MO
63011-4406
US

IV. Provider business mailing address

504 THORNLEA CT
BALLWIN MO
63011-4406
US

V. Phone/Fax

Practice location:
  • Phone: 903-821-8545
  • Fax: 314-932-0877
Mailing address:
  • Phone: 903-821-8545
  • Fax: 314-932-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMED ABO-MAHMOOD
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 903-821-8545