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General NPI Number Information
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NPI Number | 1801697347
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Entity Type | Organization
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Legal Business Name | FOOTSTAR PLLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 16211 CLAY RD STE 110
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City | HOUSTON
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State | TX
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Zip | 77084-5420
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Country | US
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Telephone | 630-656-0680
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Fax |
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Provider Business Mailing Address
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Address Line | 16211 CLAY RD STE 110
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City | HOUSTON
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State | TX
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Zip | 77084-5420
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Country | US
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Telephone | 630-656-0680
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | NIDA NISAR
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Credential | DPM
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Telephone | 630-656-0680
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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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