Provider Demographics
NPI:1669468229
Name:VAKIL, SAMIR S (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:S
Last Name:VAKIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 511269
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1269
Mailing Address - Country:US
Mailing Address - Phone:941-639-0025
Mailing Address - Fax:941-347-7271
Practice Address - Street 1:352 MILUS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4552
Practice Address - Country:US
Practice Address - Phone:941-639-0025
Practice Address - Fax:941-374-7271
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2010-03-24
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
FLPO002258213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390120300Medicaid
480015191OtherRAILROAD MEDICARE PTAN
FL77160Medicare ID - Type UnspecifiedGROUP PROVIDER #
FL390120300Medicaid