Healthcare Provider Details

I. General information

NPI: 1609133560
Provider Name (Legal Business Name): EDELWEISS PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S WASHINGTON ST
FREDERICKSBURG TX
78624-4634
US

IV. Provider business mailing address

PO BOX 3316
FREDERICKSBURG TX
78624-1916
US

V. Phone/Fax

Practice location:
  • Phone: 830-513-7861
  • Fax:
Mailing address:
  • Phone: 830-513-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1842
License Number StateTX

VIII. Authorized Official

Name: DR. ANGELA SCHLADOER
Title or Position: PODIATRIST
Credential: DPM
Phone: 830-513-7861