Provider Demographics
NPI:1124595046
Name:SOUTH FLORIDA FOOT & ANKLE INSTITUTE, LLC
Entity Type:Organization
Organization Name:SOUTH FLORIDA FOOT & ANKLE INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-900-1198
Mailing Address - Street 1:8950 SW 74TH CT STE 1408
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3173
Mailing Address - Country:US
Mailing Address - Phone:833-735-3668
Mailing Address - Fax:866-897-7014
Practice Address - Street 1:475 BILTMORE WAY STE 205
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5736
Practice Address - Country:US
Practice Address - Phone:833-735-3668
Practice Address - Fax:866-897-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100149800Medicaid