Organization Name: | SOUTH SHORE FOOT AND ANKLE INC |
NPI Number: | 1013270800 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CYNTHIA GRUNDY (OWNER) |
Mailing Address: | 1551 Sturdy Rd Valparaiso |
State: | IN US |
Postal Code: | 463837883 |
Phone Number: | 2194644100 |
Fax Number: | 2194644114 |
NPI Enumeration Date: | 06/18/2012 |
NPI Last Update Date: | 01/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 07000941A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |