Provider Demographics
NPI:1184497455
Name:PODIATRY GROUP LLC
Entity type:Organization
Organization Name:PODIATRY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUPONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-859-0569
Mailing Address - Street 1:7190 SW 87TH AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2512
Mailing Address - Country:US
Mailing Address - Phone:305-456-0772
Mailing Address - Fax:
Practice Address - Street 1:7190 SW 87TH AVE STE 403
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2512
Practice Address - Country:US
Practice Address - Phone:305-456-0772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRY GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty