Provider Demographics
NPI:1073650214
Name:AFFILIATED ANKLE AND FOOT PODIATRY CLINIC, P.C.
Entity type:Organization
Organization Name:AFFILIATED ANKLE AND FOOT PODIATRY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOTTY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOMBROWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-736-2010
Mailing Address - Street 1:244 E 90TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8102
Mailing Address - Country:US
Mailing Address - Phone:219-736-2010
Mailing Address - Fax:219-736-2013
Practice Address - Street 1:244 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8102
Practice Address - Country:US
Practice Address - Phone:219-736-2010
Practice Address - Fax:219-736-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN52000060332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCK0410OtherRAILROAD MEDICARE
INCK0405OtherRAILROAD MEDICARE PIN
IN100202580Medicaid
IN0402160002Medicare NSC
IN100202580Medicaid
IN760800Medicare PIN