Provider Demographics
NPI:1154600880
Name:ANKLES & FEET PODIATRY PC
Entity type:Organization
Organization Name:ANKLES & FEET PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANTHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-531-8771
Mailing Address - Street 1:PO BOX 382257
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35238-2257
Mailing Address - Country:US
Mailing Address - Phone:334-531-8771
Mailing Address - Fax:334-981-4513
Practice Address - Street 1:5511 HIGHWAY 280
Practice Address - Street 2:STE 124
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6585
Practice Address - Country:US
Practice Address - Phone:205-980-2005
Practice Address - Fax:205-981-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001049213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty