Provider Demographics
NPI:1477517175
Name:ANGELO P MORREALE, DPM, A PROF CORP
Entity Type:Organization
Organization Name:ANGELO P MORREALE, DPM, A PROF CORP
Other - Org Name:THE FOOT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MORREALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-357-9559
Mailing Address - Street 1:PO BOX 2817
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-0817
Mailing Address - Country:US
Mailing Address - Phone:318-357-9559
Mailing Address - Fax:318-357-1263
Practice Address - Street 1:422 DIXIE PLZ
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5881
Practice Address - Country:US
Practice Address - Phone:318-357-9559
Practice Address - Fax:318-357-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAC6593OtherBLUE CROSS BLUE SHIELD
LA0860820002Medicare NSC
LA5F955Medicare PIN
T19729Medicare UPIN
LA56585Medicare PIN
LA56585Medicare PIN