Provider Demographics
NPI:1346029105
Name:A FOOT DOCTOR LLC
Entity Type:Organization
Organization Name:A FOOT DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABO-MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-821-8545
Mailing Address - Street 1:1209 FOREST PKWY DR APT 103
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021
Mailing Address - Country:US
Mailing Address - Phone:903-821-8545
Mailing Address - Fax:314-932-0877
Practice Address - Street 1:1209 FOREST PKWY DR APT 103
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63021
Practice Address - Country:US
Practice Address - Phone:903-821-8545
Practice Address - Fax:314-932-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty