Provider Demographics
NPI:1215922349
Name:FOOT CARE GROUP, P.A.
Entity type:Organization
Organization Name:FOOT CARE GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-998-0178
Mailing Address - Street 1:1601 MILLTOWN RD
Mailing Address - Street 2:SUITE 24
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4027
Mailing Address - Country:US
Mailing Address - Phone:302-998-0178
Mailing Address - Fax:302-999-0700
Practice Address - Street 1:1601 MILLTOWN RD
Practice Address - Street 2:SUITE 24
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-998-0178
Practice Address - Fax:302-999-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEEI0000105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00829Medicare ID - Type Unspecified
U37920Medicare UPIN
5673200001Medicare NSC