| NPI | 1700327202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUTH AIDA KOSAK Owner 480-433-3265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: AZ 0798) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: AZ 0798) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0798) | |
| 261QP1100X Clinic/Center, Podiatric (Licence: AZ 0798) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2024-04-12 |