Organization
BROADWAY FOOT CLINIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SONNY O OJIKUTU DPM (VICE PRESIDENT)
(219) 884-7880
Entity
Organization
Contact information
Practice address
3290 GRANT ST, SUITE 108, GARY, IN 46408-1015
(219) 884-7880
(219) 884-7880
Mailing address
3290 GRANT ST, SUITE 108, GARY, IN 46408-1015
(219) 884-7880
(219) 884-7880
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000445A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10058560
—
IN
Enumeration date
07/03/2005
Last updated
08/22/2020
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