Provider Demographics
NPI:1467090639
Name:ANKLE FOOT AND LEG CENTERS INC.
Entity Type:Organization
Organization Name:ANKLE FOOT AND LEG CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEDRICK
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-276-9478
Mailing Address - Street 1:3075 CHESTNUT RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-3629
Mailing Address - Country:US
Mailing Address - Phone:321-591-8039
Mailing Address - Fax:904-467-3577
Practice Address - Street 1:3075 CHESTNUT RIDGE WAY
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-3629
Practice Address - Country:US
Practice Address - Phone:321-591-8039
Practice Address - Fax:904-467-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty