Basic Information
| Provider Information | |||||||||
| NPI: | 1699119214 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSTRIDE FOOT AND ANKLE SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10370 PARK RD | ||||||||
| Address2: | 100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045428253 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10370 PARK RD | ||||||||
| Address2: | 100 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282108508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7045428253 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2013 | ||||||||
| LastUpdateDate: | 09/21/2015 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7045428253 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.