Provider Demographics
NPI:1407177694
Name:AFFORDABLE FOOT AND LEG, LLC
Entity Type:Organization
Organization Name:AFFORDABLE FOOT AND LEG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:B
Authorized Official - Last Name:STAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-458-1248
Mailing Address - Street 1:2100 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3765
Mailing Address - Country:US
Mailing Address - Phone:954-458-1248
Mailing Address - Fax:954-458-1256
Practice Address - Street 1:2100 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3765
Practice Address - Country:US
Practice Address - Phone:954-458-1248
Practice Address - Fax:954-458-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3321213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEF769BOtherMEDICARE PTAN
FL6596300001OtherDME