Healthcare Provider Details

I. General information

NPI: 1467013003
Provider Name (Legal Business Name): COURTNEY M FOOTE DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3922 W MAIN STREET RD
BATAVIA NY
14020-9467
US

IV. Provider business mailing address

3922 W MAIN STREET RD
BATAVIA NY
14020-9467
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-1677
  • Fax: 585-344-2105
Mailing address:
  • Phone: 585-344-1677
  • Fax: 585-344-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN007240
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: