Organization
TIDEWATER FOOT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN THOU PRAK D.P.M (SOLE OWNER)
(757) 597-7699
Entity
Organization
Contact information
Practice address
126 MONARCH DR, NEWPORT NEWS, VA 23602-6884
(757) 597-1520
(757) 597-7099
Mailing address
11747 JEFFERSON AVE STE 2A, NEWPORT NEWS, VA 23606-4402
(757) 597-7699
(757) 597-7099
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
0103301081
VA
Other
Enumeration date
07/29/2013
Last updated
12/09/2013
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