Provider Demographics
NPI:1386844967
Name:FORNELLI FEET PA
Entity Type:Organization
Organization Name:FORNELLI FEET PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORNELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-687-9700
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-687-9700
Mailing Address - Fax:316-687-4827
Practice Address - Street 1:7224 E BAINBRIDGE CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-1140
Practice Address - Country:US
Practice Address - Phone:316-687-9700
Practice Address - Fax:316-687-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200279213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS114200Medicare PIN