Healthcare Provider Details

I. General information

NPI: 1427213354
Provider Name (Legal Business Name): ANKLE AND FOOT CENTERS OF MISSOURI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PARK LN
CHILLICOTHEE MO
64601-1560
US

IV. Provider business mailing address

407 NE 76TH TER
GLADSTONE MO
64118-1708
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-2245
  • Fax: 660-646-6088
Mailing address:
  • Phone: 816-436-7900
  • Fax: 816-436-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000747
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. AKILIS MIKE THEOHARIDIS
Title or Position: PRESIDENT
Credential: DPM
Phone: 816-436-7900