Provider Demographics
NPI:1104009836
Name:ANKLE & FOOT CENTERS OF PITTSBURGH LLC
Entity Type:Organization
Organization Name:ANKLE & FOOT CENTERS OF PITTSBURGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-787-1276
Mailing Address - Street 1:5676 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1437
Mailing Address - Country:US
Mailing Address - Phone:412-787-1276
Mailing Address - Fax:412-787-7756
Practice Address - Street 1:5676 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1437
Practice Address - Country:US
Practice Address - Phone:412-787-1276
Practice Address - Fax:412-787-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC0024557L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0078052OtherAETNA
PA0018372140004Medicaid
PA6926200OtherAETNA
PA0009271200004Medicaid
PA0009271200004Medicaid
PA0018372140004Medicaid
PA6926200OtherAETNA
PA149180Medicare PIN
PA021701ZDBPMedicare PIN