Provider Demographics
NPI:1205380482
Name:INNOVATIVE FOOT AND ANKLE CARE
Entity Type:Organization
Organization Name:INNOVATIVE FOOT AND ANKLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-923-8394
Mailing Address - Street 1:4701 OLD SHEPARD PL STE 260
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5250
Mailing Address - Country:US
Mailing Address - Phone:817-596-5077
Mailing Address - Fax:214-299-6317
Practice Address - Street 1:4701 OLD SHEPARD PL STE 260
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5250
Practice Address - Country:US
Practice Address - Phone:817-596-5077
Practice Address - Fax:214-299-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2186213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty