Provider Demographics
NPI:1851688576
Name:LOWER EXTREMITY SURGICAL GROUP PL
Entity Type:Organization
Organization Name:LOWER EXTREMITY SURGICAL GROUP PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAESSO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-907-2191
Mailing Address - Street 1:5103 SW 141ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5968
Mailing Address - Country:US
Mailing Address - Phone:954-907-2191
Mailing Address - Fax:
Practice Address - Street 1:5103 SW 141ST AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5968
Practice Address - Country:US
Practice Address - Phone:954-907-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3466213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3466OtherLICENSE