Provider Demographics
NPI:1619277647
Name:FOOT AND ANKLE ASSOCIATES OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:FOOT AND ANKLE ASSOCIATES OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-465-6921
Mailing Address - Street 1:2929 N UNIVERSITY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5047
Mailing Address - Country:US
Mailing Address - Phone:754-702-2677
Mailing Address - Fax:754-702-2689
Practice Address - Street 1:2929 N UNIVERSITY DR STE 106
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:754-702-2677
Practice Address - Fax:754-702-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2983213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6660680001OtherMEDICARE DME
FLEV936AMedicare PIN