Provider Demographics
NPI:1104014513
Name:SOUTHERNMOST FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHERNMOST FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:KORYTOWSKI
Authorized Official - Last Name:SELDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM,AAFAS
Authorized Official - Phone:305-246-4774
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:#101
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:305-246-4774
Mailing Address - Fax:305-248-4086
Practice Address - Street 1:2441 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3409
Practice Address - Country:US
Practice Address - Phone:305-856-6441
Practice Address - Fax:305-854-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390458000Medicaid
FL97752Medicare PIN
FL390458000Medicaid