Healthcare Provider Details

I. General information

NPI: 1871123372
Provider Name (Legal Business Name): LEPOER PODIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RANDALL SQ STE 408
PROVIDENCE RI
02904-7405
US

IV. Provider business mailing address

1 RANDALL SQ STE 408
PROVIDENCE RI
02904-7405
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-2000
  • Fax: 401-453-2002
Mailing address:
  • Phone: 401-453-2000
  • Fax: 401-453-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRYSIA LEPOER
Title or Position: AUTHORIZED OFFICIAL
Credential: DPM
Phone: 401-453-2001