Provider Demographics
NPI:1023468295
Name:TOOTLE, KEVIN ALLEN (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALLEN
Last Name:TOOTLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 770754
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34777-0754
Mailing Address - Country:US
Mailing Address - Phone:352-562-7590
Mailing Address - Fax:352-663-8530
Practice Address - Street 1:3900 LAKE CENTER DR STE A1
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2203
Practice Address - Country:US
Practice Address - Phone:525-627-5903
Practice Address - Fax:352-663-8530
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO4048213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery