Provider Demographics
NPI:1255408639
Name:COTTAGE HILL FOOT DOCTOR, PC
Entity type:Organization
Organization Name:COTTAGE HILL FOOT DOCTOR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:T
Authorized Official - Last Name:LANDI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:251-304-0804
Mailing Address - Street 1:1371 MONTLIMAR DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1645
Mailing Address - Country:US
Mailing Address - Phone:251-304-0804
Mailing Address - Fax:251-304-0806
Practice Address - Street 1:1371 MONTLIMAR DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1645
Practice Address - Country:US
Practice Address - Phone:251-304-0804
Practice Address - Fax:251-304-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL285213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5903070001Medicare NSC