Provider Demographics
NPI:1578905550
Name:COMPREHENSIVE FOOT AND ANKLE SPECIALISTS OF COLLIER
Entity Type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE SPECIALISTS OF COLLIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOAN
Authorized Official - Middle Name:LAM
Authorized Official - Last Name:VON DER LANCKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-331-7144
Mailing Address - Street 1:8340 COLLIER BLVD
Mailing Address - Street 2:400
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-3625
Mailing Address - Country:US
Mailing Address - Phone:239-331-7144
Mailing Address - Fax:
Practice Address - Street 1:2500 TAMIAMI TRL N
Practice Address - Street 2:206
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4470
Practice Address - Country:US
Practice Address - Phone:239-331-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3302213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty