Provider Demographics
NPI:1467512160
Name:AESTHETIC AND FAMILY PODIATRY CENTER PA
Entity Type:Organization
Organization Name:AESTHETIC AND FAMILY PODIATRY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-379-8292
Mailing Address - Street 1:5396 ANTHONY LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2447
Mailing Address - Country:US
Mailing Address - Phone:941-379-8292
Mailing Address - Fax:941-870-9198
Practice Address - Street 1:5575 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:941-379-8292
Practice Address - Fax:941-870-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2777213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty