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General NPI Number Information
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NPI Number | 1013270800
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE FOOT AND ANKLE INC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 1101 GLENDALE BLVD STE 101
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City | VALPARAISO
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State | IN
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Zip | 46383-3769
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Country | US
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Telephone | 219-464-4100
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Fax | 219-464-4114
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Provider Business Mailing Address
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Address Line | 27 ASPEN RD
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City | PORTAGE
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State | IN
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Zip | 46368-1027
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Country | US
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Telephone | 219-464-4100
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Fax | 219-464-4114
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA GRUNDY
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Credential |
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Telephone | 219-464-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07000941A
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License Number State | IN
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