Provider Demographics
NPI:1861506479
Name:FLORIDA FOOT & ANKLE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FLORIDA FOOT & ANKLE ASSOCIATES, LLC
Other - Org Name:FLORIDA FOOT & ANKLE ASSOCIATES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-662-3893
Mailing Address - Street 1:8200 NW 27TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:8200 NW 27TH ST STE 108
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1902
Practice Address - Country:US
Practice Address - Phone:786-662-3893
Practice Address - Fax:786-662-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-06-21
Deactivation Date:2009-05-22
Deactivation Code:
Reactivation Date:2009-06-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115006300Medicaid
FLAC741OtherMEDICARE GROUP
FL5884870030Medicare NSC
FL5884870033Medicare NSC
FLAC741OtherMEDICARE GROUP