Provider Demographics
NPI:1871624742
Name:FOOT DOCTOR PC
Entity type:Organization
Organization Name:FOOT DOCTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-874-8566
Mailing Address - Street 1:7000 N 16TH ST # 120
Mailing Address - Street 2:BOX 483
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5547
Mailing Address - Country:US
Mailing Address - Phone:602-874-8566
Mailing Address - Fax:602-395-1818
Practice Address - Street 1:7000 N 16TH ST # 120
Practice Address - Street 2:BOX 483
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5547
Practice Address - Country:US
Practice Address - Phone:602-874-8566
Practice Address - Fax:602-395-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480030876OtherMEDICARE RAILROAD