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General NPI Number Information
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NPI Number | 1699065839
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Entity Type | Organization
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Legal Business Name | KEITH BANGART DPM PC
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 13660 N 94TH DR STE F1
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City | PEORIA
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State | AZ
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Zip | 85381-4232
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Country | US
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Telephone | 623-974-0522
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Fax | 623-933-5787
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Provider Business Mailing Address
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Address Line | 13660 N 94TH DR STE F1
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City | PEORIA
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State | AZ
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Zip | 85381-4232
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Country | US
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Telephone | 623-974-0522
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Fax | 623-933-5787
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEITH BANGART
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Credential | DPM
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Telephone | 623-974-0522
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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 | 0724
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License Number State | AZ
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