Basic Information
| Provider Information | |||||||||
| NPI: | 1891377834 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NUCARE FOOT AND ANKLE SPECIALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16635 SPRING CYPRESS RD # 2594 | ||||||||
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| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774291713 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12238 QUEENSTON BLVD STE K | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770955351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2819820868 | ||||||||
| FaxNumber: | 2819820866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2021 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | LIN | ||||||||
| AuthorizedOfficialFirstName: | HAONAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PODIATRY | ||||||||
| AuthorizedOfficialTelephone: | 2819820868 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3031 | 01 | TX | TEXAS STATE LICENSE | OTHER |