Provider Demographics
NPI:1518942028
Name:CENTERS FOR FOOT & ANKLE CARE LLC
Entity Type:Organization
Organization Name:CENTERS FOR FOOT & ANKLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-844-8585
Mailing Address - Street 1:32743 23 MILE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2176
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:708-424-5001
Practice Address - Street 1:131 WALNUT ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2410
Practice Address - Country:US
Practice Address - Phone:812-537-4848
Practice Address - Fax:812-537-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200264580AMedicaid
OH9294775Medicare PIN
IN200264580AMedicaid
OHCN5629Medicare PIN
IN261450Medicare PIN