Provider Demographics
NPI:1497406508
Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:CERTIFIED FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DPM
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-995-0229
Mailing Address - Street 1:PO BOX 746232
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6232
Mailing Address - Country:US
Mailing Address - Phone:754-702-3359
Mailing Address - Fax:561-288-9045
Practice Address - Street 1:1285 36TH ST STE 203
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6588
Practice Address - Country:US
Practice Address - Phone:772-567-0111
Practice Address - Fax:772-257-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty