Healthcare Provider Details

I. General information

NPI: 1437331790
Provider Name (Legal Business Name): ADVANCED FOOT CARE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 SW BLUE PKWY
LEES SUMMIT MO
64063-3805
US

IV. Provider business mailing address

828 SW BLUE PKWY
LEES SUMMIT MO
64063-3805
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2900
  • Fax: 816-554-3991
Mailing address:
  • Phone: 816-525-2900
  • Fax: 816-554-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberMO461
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberMO461
License Number StateMO

VIII. Authorized Official

Name: DR. DAVID ALAN SAPPERSTEIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 816-525-2900