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General NPI Number Information
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NPI Number | 1598657504
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Entity Type | Organization
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Legal Business Name | BOARD CERTIFIED FOOTCARE LLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 111 BOSTON POST RD
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City | SUDBURY
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State | MA
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Zip | 01776-2463
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Country | US
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Telephone | 978-443-4878
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Fax |
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Provider Business Mailing Address
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Address Line | 111 BOSTON POST RD
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City | SUDBURY
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State | MA
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Zip | 01776-2463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | OMID NAVID EBRAHIMI-SOHI
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Credential |
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Telephone | 214-504-4126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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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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