Provider Demographics
NPI:1629577051
Name:AMERICAN PODIATRY GROUP INC A PROFESSIONAL PODIATRY CORPORATION
Entity Type:Organization
Organization Name:AMERICAN PODIATRY GROUP INC A PROFESSIONAL PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-362-1171
Mailing Address - Street 1:450 SUTTER STREET
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-3913
Mailing Address - Country:US
Mailing Address - Phone:415-362-1101
Mailing Address - Fax:415-362-6001
Practice Address - Street 1:450 SUTTER STREET
Practice Address - Street 2:SUITE 1101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-362-1101
Practice Address - Fax:415-362-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-12
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid