Provider Demographics
NPI:1407286974
Name:ELITE FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:ELITE FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REANEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-690-6286
Mailing Address - Street 1:16312 SHEFFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-1863
Mailing Address - Country:US
Mailing Address - Phone:402-690-6286
Mailing Address - Fax:
Practice Address - Street 1:16312 SHEFFIELD CIR
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-1863
Practice Address - Country:US
Practice Address - Phone:402-690-6286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE339213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty