Healthcare Provider Details

I. General information

NPI: 1154965051
Provider Name (Legal Business Name): UNITED FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 SHALLOWFORD RD STE 213
CHATTANOOGA TN
37421-2215
US

IV. Provider business mailing address

5959 SHALLOWFORD RD STE 213
CHATTANOOGA TN
37421-2215
US

V. Phone/Fax

Practice location:
  • Phone: 423-760-3668
  • Fax:
Mailing address:
  • Phone: 423-760-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL TODD WILES
Title or Position: PHYSICIAN
Credential: DPM
Phone: 423-760-3668