Provider Demographics
NPI:1518015106
Name:BAY AREA FOOT & ANKLE INC
Entity Type:Organization
Organization Name:BAY AREA FOOT & ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-795-4065
Mailing Address - Street 1:501 VILLAGE GREEN PKWY
Mailing Address - Street 2:STE 19
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3401
Mailing Address - Country:US
Mailing Address - Phone:941-795-4065
Mailing Address - Fax:941-795-4073
Practice Address - Street 1:501 VILLAGE GREEN PKWY
Practice Address - Street 2:STE 19
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3401
Practice Address - Country:US
Practice Address - Phone:941-795-4065
Practice Address - Fax:941-795-4073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2729213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9278Medicare PIN
5578750001Medicare NSC