Provider Demographics
NPI:1417794926
Name:PRACTICE FOR FOOT AND ANKLE LLC
Entity type:Organization
Organization Name:PRACTICE FOR FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-225-5480
Mailing Address - Street 1:1995 EDSEL LN NW STE 3
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-3008
Mailing Address - Country:US
Mailing Address - Phone:812-225-5480
Mailing Address - Fax:
Practice Address - Street 1:1995 EDSEL LN NW STE 3
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-3008
Practice Address - Country:US
Practice Address - Phone:812-225-5480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty