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BROADWAY FOOT CLINIC CORPORATION NPI 1073510244


NPI Information

NPI: 1073510244
Provider Name: BROADWAY FOOT CLINIC CORPORATION
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
3290 GRANT ST
SUITE 108
GARY, IN
ZIP 46408
Phone: (219) 884-7880
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BROADWAY FOOT CLINIC CORPORATION is a podiatrist in Gary, IN. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. BROADWAY FOOT CLINIC CORPORATION NPI is 1073510244. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3290 GRANT ST
SUITE 108
GARY, IN
ZIP 46408-015
Phone: (219) 884-7880
Fax: (219) 884-7880

The provider's authorized official is Sonny O Ojikutu .
The authorized official title is Vice President and has the following contact phone number (219) 884-7880.

The enumeration date for this NPI number is 7/3/2005 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatrist07000445AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
110058560MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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