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General NPI Number Information
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NPI Number | 1255599395
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Entity Type | Organization
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Legal Business Name | CORINTH PODIATRY GROUP
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 4967 NE GOODVIEW CIR STE B
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2493
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Country | US
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Telephone | 816-461-3535
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Fax | 816-461-8782
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Provider Business Mailing Address
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Address Line | 4967 NE GOODVIEW CIR STE B
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City | LEES SUMMIT
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State | MO
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Zip | 64064-2493
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Country | US
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Telephone | 816-461-3535
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Fax | 816-461-8782
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | MRS. JUDITH A STENGER
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Credential | CERT. SURGICAL TECH
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Telephone | 816-461-3535
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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 | 000387
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License Number State | MO
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