Provider Demographics
NPI:1982893012
Name:MORSE K UPSHAW DPM INC
Entity Type:Organization
Organization Name:MORSE K UPSHAW DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MORSE
Authorized Official - Middle Name:KILBURN
Authorized Official - Last Name:UPSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-289-1080
Mailing Address - Street 1:2142 S FREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4315
Mailing Address - Country:US
Mailing Address - Phone:626-289-1080
Mailing Address - Fax:626-289-1204
Practice Address - Street 1:2142 S FREMONT AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-4315
Practice Address - Country:US
Practice Address - Phone:626-289-1080
Practice Address - Fax:626-289-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2383213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E23831Medicaid
CA000E23831Medicaid
CAE2383Medicare PIN