Organization
ACADEMY FOOT AND ANKLE SPECIALISTS AT KELLER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL MARCIANO DPM (OWNER)
(817) 424-3668
Entity
Organization
Contact information
Practice address
4444 HERITAGE TRACE PKWY, SUITE 400, KELLER, TX 76244-5378
(817) 424-3668
(817) 442-8637
Mailing address
1940 HIGHWAY 114, SUITE 150, SOUTHLAKE, TX 76092-6526
(817) 424-3668
(817) 442-8637
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1364
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346477304
NPI
—
Enumeration date
06/17/2009
Last updated
12/12/2016
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