Provider Demographics
NPI:1760671051
Name:FOOT CLINIC OF OKLAHOMA PLLC
Entity Type:Organization
Organization Name:FOOT CLINIC OF OKLAHOMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:405-755-2334
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8305
Mailing Address - Country:US
Mailing Address - Phone:405-755-2334
Mailing Address - Fax:405-755-7803
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 308
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8305
Practice Address - Country:US
Practice Address - Phone:405-755-2334
Practice Address - Fax:405-755-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK242213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40763Medicare UPIN
OKV05667Medicare UPIN
300522364Medicare PIN
6052130001Medicare NSC