Provider Demographics
NPI:1023744240
Name:IN STEP PODIATRY SURGERY CENTER
Entity type:Organization
Organization Name:IN STEP PODIATRY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QUEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MBANUZUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-300-8661
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2905 MITCHELLVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3953
Practice Address - Country:US
Practice Address - Phone:301-430-0337
Practice Address - Fax:240-244-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty