Provider Demographics
NPI:1215184585
Name:DIABETIC FOOT INSTITUTE, LLC
Entity Type:Organization
Organization Name:DIABETIC FOOT INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:QUI
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-757-8808
Mailing Address - Street 1:5428 O'DONOVAN DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808
Mailing Address - Country:US
Mailing Address - Phone:225-757-8808
Mailing Address - Fax:225-757-8875
Practice Address - Street 1:5428 O'DONOVAN DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808
Practice Address - Country:US
Practice Address - Phone:225-757-8808
Practice Address - Fax:225-757-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6235290001Medicare NSC