Healthcare Provider Details

I. General information

NPI: 1346389095
Provider Name (Legal Business Name): FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11066 OLIVE BLVD
SAINT LOUIS MO
63141-7615
US

IV. Provider business mailing address

PO BOX 790379
SAINT LOUIS MO
63179-0379
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-4210
  • Fax: 314-692-4211
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: LOUIS AQUINO
Title or Position: PARTNER
Credential: MD
Phone: 314-692-4210