Provider Demographics
NPI:1083269955
Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Other - Org Name:MULTI-SPECIALTY PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINMON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-995-0229
Mailing Address - Street 1:1601 CLINT MOORE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5713
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:561-989-0775
Practice Address - Street 1:140 JUPITER LAKES BLVD STE A
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7196
Practice Address - Country:US
Practice Address - Phone:561-320-9298
Practice Address - Fax:772-288-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001593100Medicaid