Provider Demographics
NPI:1679273544
Name:METRO FOOT AND ANKLE SPECIALIST, PC
Entity type:Organization
Organization Name:METRO FOOT AND ANKLE SPECIALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMLYN
Authorized Official - Middle Name:KEDJU
Authorized Official - Last Name:FORSUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-968-9187
Mailing Address - Street 1:10040 REGENCY CIR STE 345
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3713
Mailing Address - Country:US
Mailing Address - Phone:402-541-8336
Mailing Address - Fax:402-512-8182
Practice Address - Street 1:10040 REGENCY CIR STE 345
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3713
Practice Address - Country:US
Practice Address - Phone:402-541-8336
Practice Address - Fax:402-512-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty