Provider Demographics
NPI:1821546540
Name:ATA PODIATRIC AND INTEGRATIVE MEDICINE, PLLC
Entity Type:Organization
Organization Name:ATA PODIATRIC AND INTEGRATIVE MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-210-5620
Mailing Address - Street 1:1950 ALASKAN WAY
Mailing Address - Street 2:APT 526
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 ALASKAN WAY
Practice Address - Street 2:APT 526
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1075
Practice Address - Country:US
Practice Address - Phone:404-210-5620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60295566213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty