Provider Demographics
NPI:1477150670
Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Other - Org Name:MULTI-SPECIALTY PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-995-0229
Mailing Address - Street 1:1601 CLINT MOORE RD STE 180
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5713
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:
Practice Address - Street 1:10446 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2819
Practice Address - Country:US
Practice Address - Phone:954-431-6050
Practice Address - Fax:954-431-5003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CERTIFIED FOOT & ANKLE SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-01
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty