Organization
FOOTPRINT PODIATRY CONSULTANTS, LLC
Active
Parent organization
FOOTPRINT PODIATRY CONSULTANTS, LLC
Other names
Footprint Podiatry Consultants, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOOTPRINT PODIATRY CONSULTANTS, LLC
Authorized official
DR. MICHANGELO DARREN SCRUGGS DPM (PODIATRIST/CEO)
(202) 506-1001
Entity
Organization
Contact information
Practice address
1328 SOUTHERN AVE SE, SUITE 209, WASHINGTON, DC 20032-4689
(202) 506-1001
(202) 506-1008
Mailing address
4316 18TH ST NW, WASHINGTON, DC 20011-4228
(202) 412-9664
(202) 525-2348
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
PO1000031
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000289842002
UNITED HEALTHCARE
DC
05
—
050785700
—
DC
01
—
306106
UNISON
DC
01
—
31290
DC CHARTERED HEALTH
DC
01
—
947AMD-MD
CAREFIRST BC/BS
DC
01
—
J892
CAREFIRST BC/BS
DC
Enumeration date
05/10/2010
Last updated
08/02/2010
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