Healthcare Provider Details

I. General information

NPI: 1104009836
Provider Name (Legal Business Name): ANKLE & FOOT CENTERS OF PITTSBURGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 STEUBENVILLE PIKE
MC KEES ROCKS PA
15136-1437
US

IV. Provider business mailing address

5676 STEUBENVILLE PIKE
MC KEES ROCKS PA
15136-1437
US

V. Phone/Fax

Practice location:
  • Phone: 412-787-1276
  • Fax: 412-787-7756
Mailing address:
  • Phone: 412-787-1276
  • Fax: 412-787-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC0024557L
License Number StatePA

VIII. Authorized Official

Name: RODNEY KOSANOVICH
Title or Position: OWNER
Credential: DPM
Phone: 412-787-1276