Provider Demographics
NPI:1760006290
Name:MODERN FOOT & ANKLE CENTERS, PLLC
Entity Type:Organization
Organization Name:MODERN FOOT & ANKLE CENTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAURINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-909-3700
Mailing Address - Street 1:2680 S VAL VISTA DR STE 177
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1674
Mailing Address - Country:US
Mailing Address - Phone:480-909-3700
Mailing Address - Fax:877-839-9972
Practice Address - Street 1:600 S DOBSON RD STE E40
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5693
Practice Address - Country:US
Practice Address - Phone:480-909-3700
Practice Address - Fax:877-839-9972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty