Provider Demographics
NPI:1598752396
Name:SALLUS, KARYN (DPM)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:
Last Name:SALLUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH ST
Mailing Address - Street 2:SUITE 120 BOX 483
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5547
Mailing Address - Country:US
Mailing Address - Phone:602-395-1818
Mailing Address - Fax:602-395-1818
Practice Address - Street 1:7000 N 16TH ST
Practice Address - Street 2:SUITE 120 BOX 483
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5547
Practice Address - Country:US
Practice Address - Phone:602-395-1818
Practice Address - Fax:602-395-1818
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0491213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ430059Medicaid
AZAZ0193680OtherBLUE CROSS BLUE SHIELD
AZ480030876OtherMEDICARE RAILROAD
AZ480030876OtherMEDICARE RAILROAD
AZAZ0193680OtherBLUE CROSS BLUE SHIELD