Provider Demographics
NPI:1942220470
Name:FEET FEET, PC
Entity Type:Organization
Organization Name:FEET FEET, PC
Other - Org Name:SOUTHLAKE FAMILY FOOT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-329-0013
Mailing Address - Street 1:1422 MAIN ST
Mailing Address - Street 2:STE 249
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7625
Mailing Address - Country:US
Mailing Address - Phone:817-329-0013
Mailing Address - Fax:817-410-1412
Practice Address - Street 1:1422 MAIN ST
Practice Address - Street 2:STE 249
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7625
Practice Address - Country:US
Practice Address - Phone:817-329-0013
Practice Address - Fax:817-410-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1434213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4330540001Medicare NSC
TX00687RMedicare PIN