Provider Demographics
NPI:1912177841
Name:CORAL SPRINGS CENTER FOR MEDICINE & SURGERY OF THE FOOT & LEG INC
Entity Type:Organization
Organization Name:CORAL SPRINGS CENTER FOR MEDICINE & SURGERY OF THE FOOT & LEG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MENASHE
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-345-5223
Mailing Address - Street 1:1725 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6089
Mailing Address - Country:US
Mailing Address - Phone:954-345-5223
Mailing Address - Fax:954-345-9985
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6089
Practice Address - Country:US
Practice Address - Phone:954-345-5223
Practice Address - Fax:954-345-9985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1763213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4641660002Medicare NSC