Provider Demographics
NPI:1609991041
Name:LB PODIATRY FOOT & ANKLE HEALTH CENTER OF FLORIDA
Entity Type:Organization
Organization Name:LB PODIATRY FOOT & ANKLE HEALTH CENTER OF FLORIDA
Other - Org Name:FOOT & ANKLE HEALTH CENTER OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:POSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-499-5757
Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:SUITE 301E
Mailing Address - City:DELRAY BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6500
Mailing Address - Country:US
Mailing Address - Phone:561-499-5757
Mailing Address - Fax:561-865-2225
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:SUITE 301E
Practice Address - City:DELRAY BCH
Practice Address - State:FL
Practice Address - Zip Code:33445-6500
Practice Address - Country:US
Practice Address - Phone:561-499-5757
Practice Address - Fax:561-865-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty