Provider Demographics
NPI:1689113409
Name:APEX FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:APEX FOOT & ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DUSHACK
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-433-0064
Mailing Address - Street 1:9400 GLADIOLUS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6699
Mailing Address - Country:US
Mailing Address - Phone:239-433-0064
Mailing Address - Fax:239-433-0224
Practice Address - Street 1:8100 ARBOR CT
Practice Address - Street 2:SECOND FLOOR BUILDING A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2865
Practice Address - Country:US
Practice Address - Phone:239-433-0064
Practice Address - Fax:239-433-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3600213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty