Provider Demographics
NPI:1497147557
Name:LAUREL FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:LAUREL FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:D P M
Authorized Official - Phone:240-447-3867
Mailing Address - Street 1:14440 CHERRY LANE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:301-953-3668
Mailing Address - Fax:301-953-3854
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-953-3668
Practice Address - Fax:301-953-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01302332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00Y88L00Medicare PIN