Provider Demographics
NPI:1639353857
Name:FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINICS OF CENTRAL CAROLINA, PC
Other - Org Name:UNC PODIATRY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:EVAN
Authorized Official - Last Name:KASHEFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:919-475-4246
Mailing Address - Street 1:2 SPRING DELL LANE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517
Mailing Address - Country:US
Mailing Address - Phone:919-475-4246
Mailing Address - Fax:919-693-9255
Practice Address - Street 1:5316 HIGHGATE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6627
Practice Address - Country:US
Practice Address - Phone:919-484-1437
Practice Address - Fax:919-806-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC402213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790211PMedicaid
NC2433273DMedicare PIN