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General NPI Number Information
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NPI Number | 1588233043
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Entity Type | Organization
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Legal Business Name | CROWN FOOT & ANKLE, LLC
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Dates
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Enumeration Date | 06/20/2021
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 756 N MAIN ST STE N
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City | CROWN POINT
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State | IN
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Zip | 46307-3268
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Country | US
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Telephone | 219-257-0255
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Fax | 219-209-5514
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Provider Business Mailing Address
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Address Line | 756 N MAIN ST STE N
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City | CROWN POINT
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State | IN
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Zip | 46307-3268
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Country | US
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Telephone | 219-257-0255
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Fax | 219-209-5514
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Authorized Official
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Title or Position | MEMBER
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Name | DR. NATASHA MANDULA
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Credential | DPM
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Telephone | 219-257-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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