Provider Demographics
NPI:1558713354
Name:ALLEGIANT PODIATRY, INC.
Entity Type:Organization
Organization Name:ALLEGIANT PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-725-2524
Mailing Address - Street 1:1101 CUMBERLAND XING
Mailing Address - Street 2:# 262
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2356
Mailing Address - Country:US
Mailing Address - Phone:219-299-4643
Mailing Address - Fax:
Practice Address - Street 1:515 SILHAVY RD
Practice Address - Street 2:APT # 2
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4452
Practice Address - Country:US
Practice Address - Phone:219-299-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001158A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty