Provider Demographics
NPI:1003221706
Name:BEVERLY HILLS FOOT AND ANKLE, P.A.
Entity Type:Organization
Organization Name:BEVERLY HILLS FOOT AND ANKLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:BALA
Authorized Official - Last Name:KRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-513-4867
Mailing Address - Street 1:3550 SW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1330
Mailing Address - Country:US
Mailing Address - Phone:352-513-4867
Mailing Address - Fax:888-314-9873
Practice Address - Street 1:3404 N LECANTO HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3569
Practice Address - Country:US
Practice Address - Phone:352-513-4867
Practice Address - Fax:888-314-9873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3609261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric