Provider Demographics
NPI:1891982914
Name:CASA GRANDE FOOT & ANKLE SPEC
Entity Type:Organization
Organization Name:CASA GRANDE FOOT & ANKLE SPEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-836-3400
Mailing Address - Street 1:PO BOX 11083
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85230-1083
Mailing Address - Country:US
Mailing Address - Phone:520-836-3400
Mailing Address - Fax:520-836-2425
Practice Address - Street 1:675 E COTTONWOOD LN
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-2023
Practice Address - Country:US
Practice Address - Phone:520-836-3400
Practice Address - Fax:520-836-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5387440001Medicare NSC
AZZ102532Medicare PIN