| Organization Name: | LAFAYETTE FOOT AND ANKLE CLINIC |
| NPI Number: | 1003099441 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENNY FAIR (OWNER) |
| Mailing Address: | 2700 Lafayette St Ste 230 Fort Wayne |
| State: | IN US |
| Postal Code: | 468061100 |
| Phone Number: | 2604589953 |
| Fax Number: | 2604589238 |
| NPI Enumeration Date: | 12/07/2007 |
| NPI Last Update Date: | 12/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 07000728 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |