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General NPI Number Information
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NPI Number | 1013557743
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Entity Type | Organization
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Legal Business Name | DOCTOR FOOTFIXER, PC
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Dates
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Enumeration Date | 01/10/2020
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 400 UNION ST
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City | LAGRANGE
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State | IN
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Zip | 46761-2286
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Country | US
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Telephone | 260-499-0888
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Fax | 260-846-6614
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Provider Business Mailing Address
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Address Line | 4 HOLLY LN
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City | ELKHART
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State | IN
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Zip | 46514-4045
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Country | US
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Telephone | 574-536-6495
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | LORI BEST
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Credential |
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Telephone | 574-536-6495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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