MEDICARE: VITALITY FOOT AND ANKLE INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	208D00000X	General Practice Physician
3	261QM1300X	Multi-Specialty Clinic/Center
4	363L00000X	Nurse Practitioner
5	213ES0103X	Foot & Ankle Surgery Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538798004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY FOOT AND ANKLE INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	26900 N LAKE PLEASANT PKWY STE 202
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1558
Country	:	US
Telephone Number	:	623-254-7111
Fax Number	:	623-254-7100

Provider Business Practice Location Address
First Line	:	26900 N LAKE PLEASANT PKWY STE 202
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1558
Country	:	US
Telephone Number	:	623-254-7111
Fax Number	:	623-254-7100

Authorized Official
Title or Position	:	CEO
Name	:	DR. YEHIA MOHAMED ELEBRASHI
Credential	:	DPM
Telephone Number	:	623-396-9752

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	10/13/2023

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