Provider Demographics
NPI:1427070408
Name:DIAGNOSTIC FOOT SPECIALISTS
Entity type:Organization
Organization Name:DIAGNOSTIC FOOT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-862-3338
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-862-3338
Mailing Address - Fax:713-862-8328
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-862-3338
Practice Address - Fax:713-862-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085279001Medicaid
TX00Z859Medicare PIN
TX4524710001Medicare NSC
TX00T49RMedicare PIN
TX00Z860Medicare PIN