Provider Demographics
NPI:1972808384
Name:PEAK FOOT AND ANKLE SPECIALISTS, INC
Entity Type:Organization
Organization Name:PEAK FOOT AND ANKLE SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:EKTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-927-6584
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:STE 308
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-927-6584
Mailing Address - Fax:510-686-8786
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:STE 308
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-927-6584
Practice Address - Fax:510-686-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4668213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFR573AMedicare UPIN