Provider Demographics
NPI:1104004613
Name:CAPE FOOT CLINIC
Entity Type:Organization
Organization Name:CAPE FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZENON
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:573-334-1080
Mailing Address - Street 1:145 S MOUNT AUBURN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4913
Mailing Address - Country:US
Mailing Address - Phone:573-334-1080
Mailing Address - Fax:573-334-2748
Practice Address - Street 1:145 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE B
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4913
Practice Address - Country:US
Practice Address - Phone:573-334-1080
Practice Address - Fax:573-334-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000021327Medicare PIN
MO0653500001Medicare NSC
MODP5000Medicare PIN