Provider Demographics
NPI:1013068709
Name:FOOT AND ANKLE CENTERS OF CHARLOTTE COUNTY PA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTERS OF CHARLOTTE COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAKIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-639-0025
Mailing Address - Street 1:PO BOX 511269
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33951-1269
Mailing Address - Country:US
Mailing Address - Phone:941-639-0025
Mailing Address - Fax:941-347-7271
Practice Address - Street 1:352 MILUS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4552
Practice Address - Country:US
Practice Address - Phone:941-639-0025
Practice Address - Fax:941-374-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO002258213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10D0294527OtherCLIA
10D0294527OtherCLIA
10D0294527OtherCLIA
FL=========OtherEIN