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General NPI Number Information
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NPI Number | 1487521134
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Entity Type | Organization
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Legal Business Name | KIRUSAM LLC.(DBA BROADWAY G FOOT ANKLE AND WOUND CARE)
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Dates
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Enumeration Date | 10/18/2025
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 2910 BROADWAY BLVD STE 212
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City | GARLAND
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State | TX
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Zip | 75041-3794
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Country | US
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Telephone | 972-435-6096
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Fax | 972-521-6953
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Provider Business Mailing Address
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Address Line | 2080 GLENCOE DR
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City | ROCKWALL
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State | TX
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Zip | 75087-2400
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Country | US
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Telephone | 619-342-6199
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Fax | 972-521-6953
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Authorized Official
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Title or Position | PHYSICIAN/MANAGER
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Name | KIRUBEL T GEBRESENBET
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Credential |
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Telephone | 972-435-6096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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