Provider Demographics
NPI:1518515980
Name:DA VINCI FOOT AND ANKLE MADISON LLC
Entity Type:Organization
Organization Name:DA VINCI FOOT AND ANKLE MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MENKE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:706-597-0102
Mailing Address - Street 1:1043 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-7318
Mailing Address - Country:US
Mailing Address - Phone:706-597-0102
Mailing Address - Fax:706-597-1998
Practice Address - Street 1:1740 LIONS CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4762
Practice Address - Country:US
Practice Address - Phone:706-597-0102
Practice Address - Fax:706-597-1998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DA VINCI FOOT AND ANKLE WEST AUGUSTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-29
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty