Provider Demographics
NPI:1083860225
Name:ADVANCED FOOT & ANKLE GROUP PLLC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHARE HOLDER
Authorized Official - Prefix:
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MBR
Authorized Official - Phone:206-361-2255
Mailing Address - Street 1:10564 5TH AVE NE
Mailing Address - Street 2:STE 103
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7200
Mailing Address - Country:US
Mailing Address - Phone:206-361-2255
Mailing Address - Fax:
Practice Address - Street 1:10564 5TH AVE NE
Practice Address - Street 2:STE 103
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7200
Practice Address - Country:US
Practice Address - Phone:206-361-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000799174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty