Provider Demographics
NPI:1407415227
Name:VITAL PODIATRY PLLC
Entity Type:Organization
Organization Name:VITAL PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RIZWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-458-0419
Mailing Address - Street 1:20834 SHAWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-1657
Mailing Address - Country:US
Mailing Address - Phone:281-937-4546
Mailing Address - Fax:346-998-1661
Practice Address - Street 1:13219 DOTSON RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4308
Practice Address - Country:US
Practice Address - Phone:281-937-4546
Practice Address - Fax:346-998-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty