Healthcare Provider Details

I. General information

NPI: 1255613642
Provider Name (Legal Business Name): METRO FOOT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 SMIZER STATION RD SUITE 3A
FENTON MO
63026-2784
US

IV. Provider business mailing address

3927 SOLUTIONS CTR
CHICAGO IL
60677-3009
US

V. Phone/Fax

Practice location:
  • Phone: 636-938-5006
  • Fax:
Mailing address:
  • Phone: 636-938-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KARA M KOZLOWSKI
Title or Position: PRESIDENT
Credential: DPM
Phone: 636-938-5006