Healthcare Provider Details

I. General information

NPI: 1194279992
Provider Name (Legal Business Name): RENO FOOT & ANKLE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 ELM ST SUITE 302
RENO NV
89503-4522
US

IV. Provider business mailing address

PO BOX 1406
RENO NV
89505-1406
US

V. Phone/Fax

Practice location:
  • Phone: 775-826-2662
  • Fax: 775-826-5121
Mailing address:
  • Phone: 775-826-2662
  • Fax: 775-826-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9202
License Number StateNV

VIII. Authorized Official

Name: MICHAEL R KRESSLER
Title or Position: MANAGER
Credential: DPM
Phone: 775-826-2662