Provider Demographics
NPI:1720686801
Name:FOOT AND ANKLE WELLNESS, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMR
Authorized Official - Middle Name:HATEM
Authorized Official - Last Name:EL-KHASHAB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-382-2081
Mailing Address - Street 1:21216 NORTHWEST FWY STE 240
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4695
Mailing Address - Country:US
Mailing Address - Phone:281-955-5500
Mailing Address - Fax:281-890-9365
Practice Address - Street 1:21216 NORTHWEST FWY STE 240
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4695
Practice Address - Country:US
Practice Address - Phone:281-955-5500
Practice Address - Fax:281-890-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1336566025OtherNPI