Provider Demographics
NPI:1588233043
Name:CROWN FOOT & ANKLE, LLC
Entity Type:Organization
Organization Name:CROWN FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDULA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-257-0255
Mailing Address - Street 1:756 N MAIN ST STE N
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3268
Mailing Address - Country:US
Mailing Address - Phone:219-257-0255
Mailing Address - Fax:219-209-5514
Practice Address - Street 1:756 N MAIN ST STE N
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3268
Practice Address - Country:US
Practice Address - Phone:219-257-0255
Practice Address - Fax:219-209-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-20
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric