Provider Demographics
NPI:1306984877
Name:ABLE PODIATRY
Entity type:Organization
Organization Name:ABLE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTIROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-223-0606
Mailing Address - Street 1:P O BOX 38561
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-0561
Mailing Address - Country:US
Mailing Address - Phone:469-223-0606
Mailing Address - Fax:214-341-8846
Practice Address - Street 1:9 MEDICAL PKWY
Practice Address - Street 2:PROFESSIONAL PLAZA 4, SUITE 304
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7858
Practice Address - Country:US
Practice Address - Phone:469-223-0606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1621213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1621OtherTX STATE LICENSE NUMBER
TXP00217354OtherMEDICARE RAILROAD CARRIER
TX8D3049OtherMEDICARE PROVIDER ID
TX0053JBOtherBLUE CROSS BLUE SHIELD ID
TX00393YOtherMEDICARE GROUP ID
TX0053JBOtherBLUE CROSS BLUE SHIELD ID
TXU76007Medicare UPIN
TXP00217354OtherMEDICARE RAILROAD CARRIER