Provider Demographics
NPI:1588633572
Name:MITCHELL BERNKNOPF DPM PA
Entity Type:Organization
Organization Name:MITCHELL BERNKNOPF DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNKNOPF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-427-3668
Mailing Address - Street 1:9805 MAJORCA PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:954-427-3668
Mailing Address - Fax:954-427-2319
Practice Address - Street 1:1367 S MILITARY TR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442
Practice Address - Country:US
Practice Address - Phone:954-427-3668
Practice Address - Fax:954-427-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02707213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65588OtherBCBS
FL390471700Medicaid
FLE0998AMedicare PIN
U71304Medicare UPIN
FL4432750001Medicare NSC