Coastal Podiatry, LLC
NPI #1659648152 in Mount Pleasant, South Carolina
Provider Information
- NPI Number
- 1659648152
- Entity Type
- Organization
- Organization Name
- Coastal Podiatry, LLC
- Primary Specialty
- Podiatrist
- Enumeration Date
- Nov 28, 2011
- Last Updated
- Dec 13, 2013
Practice Location
- Address
- 180 WINGO WAY
- Address 2
- SUITE 201
- City
- Mount Pleasant
- State
- South Carolina
- ZIP Code
- 29464-1810
- Phone
- (916) 215-1234
Authorized Official
- Name
- DR. TAMIKA MICHELLE BOLDEN RAVENELL, DPM
- Title
- OWNER
- Phone
- (916) 215-1234
Specialties & Taxonomy Codes
| Specialty |
|---|
| Podiatrist |
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