Provider Demographics
NPI:1588007876
Name:COMPLETE FOOT & ANKLE L.L.C.
Entity Type:Organization
Organization Name:COMPLETE FOOT & ANKLE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-683-4453
Mailing Address - Street 1:2350 TREMONT ST
Mailing Address - Street 2:#410
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-5030
Mailing Address - Country:US
Mailing Address - Phone:206-683-4453
Mailing Address - Fax:
Practice Address - Street 1:2350 TREMONT ST
Practice Address - Street 2:#410
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-5030
Practice Address - Country:US
Practice Address - Phone:206-683-4453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty