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General NPI Number Information
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NPI Number | 1386844967
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Entity Type | Organization
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Legal Business Name | FORNELLI FEET PA
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 7224 E BAINBRIDGE CT
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City | WICHITA
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State | KS
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Zip | 67226-1140
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Country | US
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Telephone | 316-687-9700
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Fax | 316-687-4827
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Provider Business Mailing Address
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Address Line | 1515 S CLIFTON AVE SUITE 440
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City | WICHITA
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State | KS
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Zip | 67218-2900
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Country | US
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Telephone | 316-687-9700
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Fax | 316-687-4827
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Authorized Official
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Title or Position | OWNER
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Name | DR. TONY J. FORNELLI
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Credential |
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Telephone | 316-687-9700
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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 | 1200279
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License Number State | KS
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