Provider Demographics
NPI:1104358357
Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-425-2929
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:561-989-0775
Practice Address - Street 1:2664 SW IMMANUEL DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2738
Practice Address - Country:US
Practice Address - Phone:772-288-3338
Practice Address - Fax:772-288-3341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty