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General NPI Number Information
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NPI Number | 1376160309
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Entity Type | Organization
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Legal Business Name | AMG PODIATRY LLC
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 4915 E BASELINE RD STE 121
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City | GILBERT
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State | AZ
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Zip | 85234-2969
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Country | US
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Telephone | 480-812-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 S FOLLETT WAY
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City | GILBERT
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State | AZ
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Zip | 85295-0155
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Country | US
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Telephone | 360-269-2106
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | ANDREW GOODEILL
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Credential | DPM
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Telephone | 360-269-2106
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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 |
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License Number State |
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