Healthcare Provider Details

I. General information

NPI: 1730382003
Provider Name (Legal Business Name): FAMILY FOOT CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 N BECKLEY AVE STE 456
DALLAS TX
75203-1593
US

IV. Provider business mailing address

1675 REPUBLIC PKWY SUITE 101
MESQUITE TX
75150-6903
US

V. Phone/Fax

Practice location:
  • Phone: 214-943-2621
  • Fax: 972-270-7759
Mailing address:
  • Phone: 972-270-7627
  • Fax: 972-270-7759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0425
License Number StateTX

VIII. Authorized Official

Name: MICHAEL J MILLER
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 972-270-7627