Provider Demographics
NPI:1871655381
Name:RECONSTRUCTIVE FOOT & ANKLE INSTITUTE, LLC
Entity Type:Organization
Organization Name:RECONSTRUCTIVE FOOT & ANKLE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-797-8554
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21705-0269
Mailing Address - Country:US
Mailing Address - Phone:301-797-8554
Mailing Address - Fax:301-797-9228
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:SUITE C
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5852
Practice Address - Country:US
Practice Address - Phone:301-797-8554
Practice Address - Fax:301-797-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD290AOtherCAREFIRST MD
DCJ323OtherBCBS
MDDC3915OtherMEDICARE RAILROAD
MD290AOtherCAREFIRST MD
MDDC3915OtherMEDICARE RAILROAD