Organization
CLIFTON FOOT AND ANKLE CENTER P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH REED WILHELM DPM (PRESIDENT)
(703) 996-3000
Entity
Organization
Contact information
Practice address
6101 REDWOOD SQUARE CENTER, SUITE 303, CENTREVILLE, VA 20121-4269
(703) 996-3000
(703) 229-1152
Mailing address
6101 REDWOOD SQUARE CTR, SUITE 303, CENTREVILLE, VA 20121-4265
(703) 996-3000
(703) 229-1152
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103000986
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009302531
—
VA
01
—
6614380001
DME PTAN
VA
Enumeration date
10/26/2011
Last updated
05/13/2013
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