Healthcare Provider Details

I. General information

NPI: 1669625901
Provider Name (Legal Business Name): AUSTIN PODIATRY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST STE 3A
AUSTIN TX
78745-1251
US

IV. Provider business mailing address

4310 JAMES CASEY ST STE 3A
AUSTIN TX
78745-1251
US

V. Phone/Fax

Practice location:
  • Phone: 512-448-3668
  • Fax: 512-448-4460
Mailing address:
  • Phone: 512-448-3668
  • Fax: 512-448-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1871
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0582
License Number StateTX

VIII. Authorized Official

Name: DR. MICHAEL H GOLF
Title or Position: OWNER
Credential: D.P.M.
Phone: 512-448-3668