Provider Demographics
NPI:1386384790
Name:FOOT ENVY, LLC
Entity type:Organization
Organization Name:FOOT ENVY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:KENYON
Authorized Official - Last Name:UDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-248-4734
Mailing Address - Street 1:14539 W INDIAN SCHOOL RD STE 880
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9279
Mailing Address - Country:US
Mailing Address - Phone:623-248-4734
Mailing Address - Fax:623-259-7006
Practice Address - Street 1:14539 W INDIAN SCHOOL RD STE 880
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9279
Practice Address - Country:US
Practice Address - Phone:623-248-4734
Practice Address - Fax:623-259-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty