Provider Demographics
NPI:1659562015
Name:A WELL-HEALED FOOT PA
Entity Type:Organization
Organization Name:A WELL-HEALED FOOT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIKI
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:TRAN-BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-249-5050
Mailing Address - Street 1:6301 MEMORIAL HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4573
Mailing Address - Country:US
Mailing Address - Phone:813-249-5050
Mailing Address - Fax:813-358-3582
Practice Address - Street 1:6301 MEMORIAL HWY STE 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615
Practice Address - Country:US
Practice Address - Phone:813-249-5050
Practice Address - Fax:813-358-3582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6194670001Medicare NSC
FLDO2583Medicare UPIN
FLP00666796Medicare UPIN
FLU96217Medicare UPIN