Healthcare Provider Details

I. General information

NPI: 1457403057
Provider Name (Legal Business Name): ABSOLUTE FOOT CARE SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 GRAND MONTECITO PKWY ST. 110
LAS VEGAS NV
89149-0260
US

IV. Provider business mailing address

7125 GRAND MONTECITO PKWY ST. 110
LAS VEGAS NV
89149-0260
US

V. Phone/Fax

Practice location:
  • Phone: 702-839-2010
  • Fax: 702-839-2977
Mailing address:
  • Phone: 702-839-2010
  • Fax: 702-839-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0110
License Number StateNV

VIII. Authorized Official

Name: DR. NOAH LEVINE
Title or Position: DOCTOR
Credential: DPM
Phone: 702-839-2010