Provider Demographics
NPI:1497059240
Name:ORTHOPEDIC FOOT AND ANKLE INSTITUTE, LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC FOOT AND ANKLE INSTITUTE, LLC
Other - Org Name:COMPREHENSIVE PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-997-9833
Mailing Address - Street 1:3175 SAINT ROSE PKWY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3506
Mailing Address - Country:US
Mailing Address - Phone:702-997-9833
Mailing Address - Fax:702-666-0413
Practice Address - Street 1:3175 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3506
Practice Address - Country:US
Practice Address - Phone:702-997-9833
Practice Address - Fax:702-666-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Single Specialty