Provider Demographics
NPI:1962465815
Name:FOOTHILLS FOOT & ANKLE INC
Entity Type:Organization
Organization Name:FOOTHILLS FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MURAD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:520-795-3795
Mailing Address - Street 1:1601 N TUSCON BLVD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3421
Mailing Address - Country:US
Mailing Address - Phone:520-795-3795
Mailing Address - Fax:520-325-9861
Practice Address - Street 1:1601 N TUSCON BLVD
Practice Address - Street 2:SUITE 35
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3421
Practice Address - Country:US
Practice Address - Phone:520-795-3795
Practice Address - Fax:520-325-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106587Medicare PIN
AZ5483620001Medicare NSC