Organization
CASCADE FOOT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMBROSE K SU DPM (OWNER)
(541) 382-7521
Entity
Organization
Contact information
Practice address
2408 NE DIVISION ST, BEND, OR 97701-3543
(541) 382-7521
(541) 382-6297
Mailing address
2408 NE DIVISION ST, BEND, OR 97701-3543
(541) 382-7521
(541) 382-6297
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
DP00128
OR
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
DP00159
OR
Other
Enumeration date
06/04/2007
Last updated
08/28/2013
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