Provider Demographics
NPI:1912645250
Name:FOOT ANKLE & LOWER LEG SPECIALISTS
Entity Type:Organization
Organization Name:FOOT ANKLE & LOWER LEG SPECIALISTS
Other - Org Name:FOOT ANKLE & LOWER LEG SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YILMA
Authorized Official - Middle Name:KEBEDE
Authorized Official - Last Name:KEBELO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DPM
Authorized Official - Phone:408-829-2904
Mailing Address - Street 1:660 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1931
Mailing Address - Country:US
Mailing Address - Phone:669-977-0200
Mailing Address - Fax:669-333-3310
Practice Address - Street 1:660 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1931
Practice Address - Country:US
Practice Address - Phone:669-977-0200
Practice Address - Fax:669-333-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty