Provider Demographics
NPI:1407377344
Name:FUSION FOOT AND ANKLE, LLC
Entity Type:Organization
Organization Name:FUSION FOOT AND ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-367-8115
Mailing Address - Street 1:110 US HIGHWAY 6
Mailing Address - Street 2:SUITE 80
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 US HWY 6 SUITE 80
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:908-367-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty