Provider Demographics
NPI:1538798004
Name:VITALITY FOOT AND ANKLE INSTITUTE PLLC
Entity type:Organization
Organization Name:VITALITY FOOT AND ANKLE INSTITUTE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YEHIA
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:ELEBRASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-396-9752
Mailing Address - Street 1:26900 N LAKE PLEASANT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1558
Mailing Address - Country:US
Mailing Address - Phone:623-254-7111
Mailing Address - Fax:623-254-7100
Practice Address - Street 1:26900 N LAKE PLEASANT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1558
Practice Address - Country:US
Practice Address - Phone:623-254-7111
Practice Address - Fax:623-254-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1548615875Medicaid