Provider Demographics
NPI:1275876542
Name:APACHE FOOT & ANKLE SPECIALIST LLC
Entity Type:Organization
Organization Name:APACHE FOOT & ANKLE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WITTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-362-2622
Mailing Address - Street 1:8530 W SUNSET RD STE 345
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2247
Mailing Address - Country:US
Mailing Address - Phone:702-362-2622
Mailing Address - Fax:702-362-0422
Practice Address - Street 1:8530 W SUNSET RD STE 345
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2247
Practice Address - Country:US
Practice Address - Phone:702-362-2622
Practice Address - Fax:702-362-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty