Provider Demographics
NPI:1841578705
Name:ANKLE & FOOT SPECIALIST OF PUGET SOUND, PS
Entity Type:Organization
Organization Name:ANKLE & FOOT SPECIALIST OF PUGET SOUND, PS
Other - Org Name:ANKLE & FOOT SPECIALIST OF BONNEY LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-449-2471
Mailing Address - Street 1:2728 E MAIN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3198
Mailing Address - Country:US
Mailing Address - Phone:253-841-2006
Mailing Address - Fax:
Practice Address - Street 1:10004 204TH AVE E STE 2700
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6535
Practice Address - Country:US
Practice Address - Phone:253-848-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANKLE & FOOT SPECIALIST OF PUGET SOUND, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000277213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8906838Medicare PIN