Provider Demographics
NPI:1003912957
Name:CROSSROADS PODIATRIC SURGERY CENTER, L.L.C.
Entity Type:Organization
Organization Name:CROSSROADS PODIATRIC SURGERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-363-4343
Mailing Address - Street 1:20 CROSSROADS DR
Mailing Address - Street 2:SUITE 15
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5419
Mailing Address - Country:US
Mailing Address - Phone:410-363-4343
Mailing Address - Fax:410-356-6373
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:SUITE 15
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-363-4343
Practice Address - Fax:410-356-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD225ZMedicare PIN