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General NPI Number Information
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NPI Number | 1083932438
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Entity Type | Organization
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Legal Business Name | FOOTPRINT PODIATRY CONSULTANTS, LLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 1328 SOUTHERN AVE SE SUITE 209
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City | WASHINGTON
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State | DC
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Zip | 20032-4689
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Country | US
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Telephone | 202-506-1001
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Fax | 202-506-1008
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Provider Business Mailing Address
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Address Line | 4316 18TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-4228
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Country | US
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Telephone | 202-412-9664
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Fax | 202-525-2348
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Authorized Official
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Title or Position | PODIATRIST/CEO
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Name | DR. MICHANGELO DARREN SCRUGGS
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Credential | DPM
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Telephone | 202-506-1001
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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 | PO1000031
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License Number State | DC
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