Provider Demographics
NPI:1083479752
Name:ONE STOP FOOT AND ANKLE CARE LLC
Entity Type:Organization
Organization Name:ONE STOP FOOT AND ANKLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURAKOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-778-2100
Mailing Address - Street 1:1880 N CONGRESS AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8675
Mailing Address - Country:US
Mailing Address - Phone:561-778-2100
Mailing Address - Fax:561-778-2118
Practice Address - Street 1:1880 N CONGRESS AVE STE 309
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8675
Practice Address - Country:US
Practice Address - Phone:561-778-2100
Practice Address - Fax:561-778-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty