Provider Demographics
NPI:1124112180
Name:ARIZONA FOOT HEALTH, P.C.
Entity type:Organization
Organization Name:ARIZONA FOOT HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-402-0421
Mailing Address - Street 1:11209 N TATUM BLVD STE B100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3091
Mailing Address - Country:US
Mailing Address - Phone:602-973-3888
Mailing Address - Fax:602-973-3028
Practice Address - Street 1:11209 N TATUM BLVD STE B100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3091
Practice Address - Country:US
Practice Address - Phone:602-973-3888
Practice Address - Fax:602-973-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75721Medicare ID - Type Unspecified
AZ4961410001Medicare NSC