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General NPI Number Information
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NPI Number | 1861906703
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Entity Type | Organization
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Legal Business Name | HARNESS PODIATRY HEALTH & WELLNESS
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 330 1ST CAPITOL DR STE 340
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2852
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Country | US
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Telephone | 636-600-8011
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Fax | 636-395-4043
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Provider Business Mailing Address
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Address Line | 1035 BELLEVUE AVE STE 315
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City | SAINT LOUIS
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State | MO
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Zip | 63117-1856
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Country | US
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Telephone | 314-473-1296
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN D HARNESS
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Credential | DPM
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Telephone | 636-600-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2004024287
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License Number State | MO
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