1932395464 NPI number — THE INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932395464 NPI number — THE INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932395464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9120 DOUBLETREE DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWN POINT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46307-7655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-779-9407
Provider Business Mailing Address Fax Number:
219-779-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9239 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-7046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-736-1010
Provider Business Practice Location Address Fax Number:
219-736-1090
Provider Enumeration Date:
09/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELSAMAD
Authorized Official First Name:
AHMAD
Authorized Official Middle Name:
KASSEM
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
219-488-6409

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  07001024A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200824830A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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