Provider Demographics
NPI:1447600614
Name:PALM BEACH PODIATRY FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:PALM BEACH PODIATRY FOOT AND ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:EMERSON
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-433-5660
Mailing Address - Street 1:9247 OAK ALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6186
Mailing Address - Country:US
Mailing Address - Phone:561-433-5660
Mailing Address - Fax:
Practice Address - Street 1:2326 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7617
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:561-275-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty