Provider Demographics
NPI:1790046290
Name:BROWARD FOOT AND ANKLE SPECIALIST P A
Entity Type:Organization
Organization Name:BROWARD FOOT AND ANKLE SPECIALIST P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EFROSINI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-582-4010
Mailing Address - Street 1:2205 BAY DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-2912
Mailing Address - Country:US
Mailing Address - Phone:917-582-4010
Mailing Address - Fax:718-766-8606
Practice Address - Street 1:2205 BAY DR
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-2912
Practice Address - Country:US
Practice Address - Phone:917-582-4010
Practice Address - Fax:718-766-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010144200Medicaid