Provider Demographics
NPI:1225131626
Name:DUNDEE PODIATRY AND THERAPY SERVICES PA
Entity Type:Organization
Organization Name:DUNDEE PODIATRY AND THERAPY SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-439-4000
Mailing Address - Street 1:220 LAKE LINK RD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-1003
Mailing Address - Country:US
Mailing Address - Phone:863-439-4000
Mailing Address - Fax:863-439-2257
Practice Address - Street 1:106 CENTER ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4374
Practice Address - Country:US
Practice Address - Phone:863-439-4000
Practice Address - Fax:863-439-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2449213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4475990001OtherPALMETTO GBA
FL340224000Medicaid
FL480033826OtherRAILROAD MEDICARE
FL4475990001OtherPALMETTO GBA
U87345Medicare UPIN