Basic Information
| Provider Information | |||||||||
| NPI: | 1487135885 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTRIDE FOOT & ANKLE SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 LEE ANN DR NE | ||||||||
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| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048861918 | ||||||||
| FaxNumber: | 7042572049 | ||||||||
| Practice Location | |||||||||
| Address1: | 1514 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276082368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198290076 | ||||||||
| FaxNumber: | 9198369094 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2018 | ||||||||
| LastUpdateDate: | 08/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCDONALD | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7047864482 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | NC | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | NC | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213EP1101X | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
No ID Information.