Provider Demographics
NPI:1932112349
Name:FOOT AND ANKLE MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:CMRS
Authorized Official - Phone:239-263-0200
Mailing Address - Street 1:681 GOODLETTE RD N
Mailing Address - Street 2:SUITE 160
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5458
Mailing Address - Country:US
Mailing Address - Phone:239-263-0200
Mailing Address - Fax:239-263-8435
Practice Address - Street 1:681 GOODLETTE RD N
Practice Address - Street 2:SUITE 160
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5458
Practice Address - Country:US
Practice Address - Phone:239-263-0200
Practice Address - Fax:239-263-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1760213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL98023OtherBLUECROSS AND BLUESHIELD
FL4521140001Medicare NSC