Provider Demographics
NPI:1639293806
Name:AESTHETIC AND FAMILY PODIATRY CENTER
Entity Type:Organization
Organization Name:AESTHETIC AND FAMILY PODIATRY CENTER
Other - Org Name:LISA N. KLEMEYER DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:KLEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-379-8292
Mailing Address - Street 1:5537 MARQUESAS CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-3332
Mailing Address - Country:US
Mailing Address - Phone:941-379-8292
Mailing Address - Fax:
Practice Address - Street 1:5537 MARQUESAS CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-3332
Practice Address - Country:US
Practice Address - Phone:941-379-8292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2777332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4518660001OtherDME MEDICARE
FLU75794Medicare UPIN
FL65621Medicare ID - Type Unspecified