Provider Demographics
NPI:1669843611
Name:ARCADIA FOOT & ANKLE PC
Entity Type:Organization
Organization Name:ARCADIA FOOT & ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-335-2577
Mailing Address - Street 1:PO BOX 20490
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-0490
Mailing Address - Country:US
Mailing Address - Phone:480-296-7642
Mailing Address - Fax:480-296-7643
Practice Address - Street 1:220 N STAPLEY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8057
Practice Address - Country:US
Practice Address - Phone:480-833-5966
Practice Address - Fax:480-962-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0762213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ516385Medicaid
AZ516385Medicaid