Provider Demographics
NPI:1497773782
Name:MONTGOMERY FOOT CARE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:MONTGOMERY FOOT CARE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-396-3668
Mailing Address - Street 1:1831 HALCYON BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8044
Mailing Address - Country:US
Mailing Address - Phone:334-396-3668
Mailing Address - Fax:334-396-3660
Practice Address - Street 1:1831 HALCYON BLVD.
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8044
Practice Address - Country:US
Practice Address - Phone:334-396-3668
Practice Address - Fax:334-396-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL185 AND 186213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2710201OtherUNITED HEALTH CARE
AL480026191OtherMEDICARE RAILROAD
AL51079568OtherBLUE CROSS OF ALABAMA
AL51079567OtherBLUE CROSS OF ALABAMA
AL480025888OtherMEDICARE RAILROAD
AL480025888OtherMEDICARE RAILROAD
ALU70041Medicare UPIN
AL4106750001Medicare NSC
AL51079567OtherBLUE CROSS OF ALABAMA
AL000079568Medicare PIN