Provider Demographics
NPI:1821366154
Name:ARIZONA FOOTCARE, PC
Entity Type:Organization
Organization Name:ARIZONA FOOTCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETRUSIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOWANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-264-9121
Mailing Address - Street 1:520 E BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1207
Mailing Address - Country:US
Mailing Address - Phone:602-264-9121
Mailing Address - Fax:602-264-9122
Practice Address - Street 1:520 E BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1207
Practice Address - Country:US
Practice Address - Phone:602-264-9121
Practice Address - Fax:602-264-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ535213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480032678OtherPALMETTO BGA
AZ575483Medicaid
AZ480032678OtherPALMETTO BGA
AZU64518Medicare UPIN