Provider Demographics
NPI:1992206700
Name:CENTRAL TEXAS FOOT SPECIALIST PA
Entity Type:Organization
Organization Name:CENTRAL TEXAS FOOT SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:KUKLA
Authorized Official - Last Name:PIETZSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:512-819-4555
Mailing Address - Street 1:3316 WILLIAMS DR STE 120
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2891
Mailing Address - Country:US
Mailing Address - Phone:512-819-4555
Mailing Address - Fax:
Practice Address - Street 1:301 DENALI PASS STE 1
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2079
Practice Address - Country:US
Practice Address - Phone:512-819-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL TEXAS FOOT SPECIALIST, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty