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General NPI Number Information
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NPI Number | 1558713354
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Entity Type | Organization
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Legal Business Name | ALLEGIANT PODIATRY, INC.
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 515 SILHAVY RD APT # 2
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City | VALPARAISO
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State | IN
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Zip | 46383-4452
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Country | US
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Telephone | 219-299-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 CUMBERLAND XING # 262
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City | VALPARAISO
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State | IN
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Zip | 46383-2356
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Country | US
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Telephone | 219-299-4643
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY FITZGERALD
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Credential | DPM
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Telephone | 305-725-2524
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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 | 07001158A
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License Number State | IN
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