Healthcare Provider Details

I. General information

NPI: 1427170729
Provider Name (Legal Business Name): COMPREHENSIVE FOOT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SION FARM COMMERCIAL CENTER SUITE 7
ST. CROIX VI
00820
US

IV. Provider business mailing address

4100 SION FARM COMMERCIAL CENTER. SUITE 7
ST. CROIX VI
00820
US

V. Phone/Fax

Practice location:
  • Phone: 340-713-8397
  • Fax: 340-719-5103
Mailing address:
  • Phone: 340-713-8397
  • Fax: 340-719-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1058
License Number StateVI

VIII. Authorized Official

Name: DR. IAN KEITH COOK
Title or Position: PODIATRIST
Credential: DPM
Phone: 340-713-8397