Provider Demographics
NPI:1427213354
Name:ANKLE AND FOOT CENTERS OF MISSOURI
Entity Type:Organization
Organization Name:ANKLE AND FOOT CENTERS OF MISSOURI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKILIS
Authorized Official - Middle Name:MIKE
Authorized Official - Last Name:THEOHARIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-436-7900
Mailing Address - Street 1:407 NE 76TH TER
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1708
Mailing Address - Country:US
Mailing Address - Phone:816-436-7900
Mailing Address - Fax:816-436-0999
Practice Address - Street 1:530 PARK LN
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:MO
Practice Address - Zip Code:64601-1560
Practice Address - Country:US
Practice Address - Phone:660-646-2245
Practice Address - Fax:660-646-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000747213E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505265017Medicaid