Provider Demographics
NPI:1790374874
Name:A FOOT ABOVE PODIATRY, PLLC
Entity Type:Organization
Organization Name:A FOOT ABOVE PODIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-570-6827
Mailing Address - Street 1:11545 E QUINTANA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-4102
Mailing Address - Country:US
Mailing Address - Phone:480-570-6827
Mailing Address - Fax:
Practice Address - Street 1:11545 E QUINTANA AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-4102
Practice Address - Country:US
Practice Address - Phone:480-570-6827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty