Provider Demographics
NPI:1518536200
Name:AVID FOOT & ANKLE CENTER, PLLC
Entity Type:Organization
Organization Name:AVID FOOT & ANKLE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAE SIK
Authorized Official - Middle Name:ALEX
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:469-430-9987
Mailing Address - Street 1:2601 LITTLE ELM PKWY STE 803
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-1920
Mailing Address - Country:US
Mailing Address - Phone:469-430-9987
Mailing Address - Fax:972-767-3608
Practice Address - Street 1:2601 LITTLE ELM PKWY STE 803
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-1920
Practice Address - Country:US
Practice Address - Phone:469-430-9987
Practice Address - Fax:972-767-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty