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General NPI Number Information
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NPI Number | 1902182660
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Entity Type | Organization
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Legal Business Name | CLIFTON FOOT AND ANKLE CENTER P.C.
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 6101 REDWOOD SQUARE CENTER SUITE 303
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City | CENTREVILLE
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State | VA
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Zip | 20121-4269
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Country | US
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Telephone | 703-996-3000
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Fax | 703-229-1152
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Provider Business Mailing Address
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Address Line | 6101 REDWOOD SQUARE CTR SUITE 303
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City | CENTREVILLE
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State | VA
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Zip | 20121-4265
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Country | US
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Telephone | 703-996-3000
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Fax | 703-229-1152
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH REED WILHELM
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Credential | DPM
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Telephone | 703-996-3000
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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 | 0103000986
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License Number State | VA
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