Organization
BROADWAY FOOT & ANKLE CLINIC, PC
Active
Other names
Broadway Foot Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIOT MICHAEL DPM (DPM)
(503) 648-2200
Entity
Organization
Contact information
Practice address
3508 NE BROADWAY ST, PORTLAND, OR 97232-1821
(503) 282-8777
(503) 282-8853
Mailing address
3508 NE BROADWAY ST, PORTLAND, OR 97232-1821
(503) 282-8777
(503) 282-8853
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00179
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00244
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00315
OR
Other
Enumeration date
01/31/2007
Last updated
08/07/2009
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