Provider Demographics
NPI:1245931740
Name:RENEW FOOT CARE GROUP LLC
Entity type:Organization
Organization Name:RENEW FOOT CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-741-6768
Mailing Address - Street 1:2035 BRIARBEND CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5833
Mailing Address - Country:US
Mailing Address - Phone:618-741-6768
Mailing Address - Fax:
Practice Address - Street 1:2035 BRIARBEND CT
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5833
Practice Address - Country:US
Practice Address - Phone:618-741-6768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty