Provider Demographics
NPI:1295266641
Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-786-4482
Mailing Address - Street 1:1022 LEE ANN DR NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2911
Mailing Address - Country:US
Mailing Address - Phone:704-886-1918
Mailing Address - Fax:
Practice Address - Street 1:4113 OLEANDER DR
Practice Address - Street 2:SUITE G
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6839
Practice Address - Country:US
Practice Address - Phone:910-791-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC606213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty