Provider Demographics
NPI:1174212229
Name:DOCTOR FOOT CARE, PLLC
Entity type:Organization
Organization Name:DOCTOR FOOT CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-427-1422
Mailing Address - Street 1:10020 MONROE RD
Mailing Address - Street 2:SUITE 170 - 127
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:980-737-3957
Mailing Address - Fax:
Practice Address - Street 1:1325 BRAEBURN RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4770
Practice Address - Country:US
Practice Address - Phone:646-427-1422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty