Healthcare Provider Details

I. General information

NPI: 1508949256
Provider Name (Legal Business Name): FAMILY FOOT CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9318 S TOLEDO CT
TULSA OK
74137-2746
US

IV. Provider business mailing address

9318 S TOLEDO CT
TULSA OK
74137-2746
US

V. Phone/Fax

Practice location:
  • Phone: 918-294-3668
  • Fax: 918-747-2759
Mailing address:
  • Phone: 918-294-3668
  • Fax: 918-747-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number158
License Number StateOK

VIII. Authorized Official

Name: DR. TIMOTHY NICHOLAS MALAVOLTI
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 918-294-3668