Provider Demographics
NPI:1861646002
Name:ADVANCED FOOT & ANKLE OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:MAHAVIR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-521-7999
Mailing Address - Street 1:1140 KELTON AVE
Mailing Address - Street 2:BLDG #3
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3175
Mailing Address - Country:US
Mailing Address - Phone:407-521-7999
Mailing Address - Fax:407-521-2227
Practice Address - Street 1:1140 KELTON AVE
Practice Address - Street 2:BLDG #3
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3175
Practice Address - Country:US
Practice Address - Phone:407-521-7999
Practice Address - Fax:407-521-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty