Provider Demographics
NPI:1942974563
Name:HARLIS FAMILY FOOT AND ANKLE LLC
Entity Type:Organization
Organization Name:HARLIS FAMILY FOOT AND ANKLE LLC
Other - Org Name:HARLIS FOOT AND ANKLE CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER/ MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARLIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-330-6049
Mailing Address - Street 1:1680 SE LYNGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4300
Mailing Address - Country:US
Mailing Address - Phone:772-210-3339
Mailing Address - Fax:772-404-7819
Practice Address - Street 1:1680 SE LYNGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4300
Practice Address - Country:US
Practice Address - Phone:772-210-3339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992156327OtherNPI
FL111951400Medicaid
FL1801280862OtherNPI