Provider Demographics
NPI:1184688913
Name:BERNKNOPF, MITCHELL (DPM)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BERNKNOPF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9805 MAJORCA PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3713
Mailing Address - Country:US
Mailing Address - Phone:561-866-8596
Mailing Address - Fax:
Practice Address - Street 1:1367 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-7634
Practice Address - Country:US
Practice Address - Phone:954-427-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2707213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65588OtherBCBS
FL390471700Medicaid
FL390471700Medicaid
FL65588OtherBCBS