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General NPI Number Information
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NPI Number | 1619017548
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Entity Type | Organization
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Legal Business Name | SUBURBAN FOOT CARE
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11709 OLD BALLAS RD SUITE 202
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City | CREVE COEUR
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-432-5683
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Fax | 314-997-7212
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Provider Business Mailing Address
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Address Line | 11709 OLD BALLAS RD SUITE 202
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City | CREVE COEUR
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State | MO
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Zip | 63141-7029
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Country | US
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Telephone | 314-432-5683
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Fax | 314-997-7212
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Authorized Official
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Title or Position | OWNERPODIATRIST
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Name | DR. MARK P. COMESS
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Credential | D.P.M.
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Telephone | 314-432-5683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 000410
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License Number State | MO
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