Healthcare Provider Details

I. General information

NPI: 1871718817
Provider Name (Legal Business Name): FOOT CLINIC OF OKLAHOMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 308
OKLAHOMA CITY OK
73120-8305
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 308
OKLAHOMA CITY OK
73120-8305
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-2334
  • Fax: 405-755-7803
Mailing address:
  • Phone: 405-755-2334
  • Fax: 405-755-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA L SCHUFF
Title or Position: OWNER
Credential: DPM
Phone: 405-755-2334