Provider Demographics
NPI:1023416286
Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Entity type:Organization
Organization Name:ANKLE & FOOT SPECIALISTS OF PUGET SOUND, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRISTS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-449-2471
Mailing Address - Street 1:2820 GRIFFIN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2373
Mailing Address - Country:US
Mailing Address - Phone:360-825-2181
Mailing Address - Fax:
Practice Address - Street 1:2820 GRIFFIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2373
Practice Address - Country:US
Practice Address - Phone:360-825-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty