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General NPI Number Information
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NPI Number | 1093932337
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Entity Type | Organization
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Legal Business Name | FAMILY FOOTCARE
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 1900 E NORTHERN PKWY SUITE 204
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City | BALTIMORE
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State | MD
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Zip | 21239-2113
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Country | US
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Telephone | 410-464-1284
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Fax | 410-464-1286
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Provider Business Mailing Address
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Address Line | 20 CROSSROADS DR STE 15
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5479
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Country | US
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Telephone | 410-363-4343
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Fax | 410-356-6373
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Authorized Official
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Title or Position | OWNER
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Name | MIKEL DANIELS
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Credential | DPM
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Telephone | 410-363-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | M00338
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License Number State | MD
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