Provider Demographics
NPI:1447483722
Name:FOOT AND ANKLE INSTITUTE, PLLC
Entity type:Organization
Organization Name:FOOT AND ANKLE INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LA FONTANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:515-223-5219
Mailing Address - Street 1:3613 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3273
Mailing Address - Country:US
Mailing Address - Phone:515-223-5219
Mailing Address - Fax:515-223-9344
Practice Address - Street 1:3613 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-3273
Practice Address - Country:US
Practice Address - Phone:515-223-5219
Practice Address - Fax:515-223-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00597213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7655OtherMEDICARE ID-TYPE UNSPECIFIED
IADS1680OtherRAILROAD MEDICARE
IA6330060001Medicare NSC
IAU47297Medicare UPIN
IAIB1520Medicare PIN
IAI7655OtherMEDICARE ID-TYPE UNSPECIFIED
IAIB1519Medicare PIN