Provider Demographics
NPI:1760676092
Name:ADVANCED FOOT CARE OF NORTHERN KY
Entity type:Organization
Organization Name:ADVANCED FOOT CARE OF NORTHERN KY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:859-291-9100
Mailing Address - Street 1:1880 ASHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2602
Mailing Address - Country:US
Mailing Address - Phone:859-291-9100
Mailing Address - Fax:859-291-9101
Practice Address - Street 1:1880 ASHWOOD CIR
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2602
Practice Address - Country:US
Practice Address - Phone:859-291-9100
Practice Address - Fax:859-291-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYK237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty