Individual
DR. IBN ANSARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
718 BROUGHTON ST, ORANGEBURG, SC 29115-6648
(803) 531-2888
Mailing address
718 BROUGHTON ST APT 303, ORANGEBURG, SC 29115-6648
(803) 256-6776
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
714
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
05/15/2017
Last updated
03/27/2024
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