Provider Demographics
NPI:1205256617
Name:GOLDENFEET INC
Entity type:Organization
Organization Name:GOLDENFEET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:386-490-9990
Mailing Address - Street 1:4877 PALM COAST PKWY NW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-3677
Mailing Address - Country:US
Mailing Address - Phone:386-490-9990
Mailing Address - Fax:386-263-8768
Practice Address - Street 1:4877 PALM COAST PKWY NW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3677
Practice Address - Country:US
Practice Address - Phone:386-490-9990
Practice Address - Fax:386-263-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012374100Medicaid
FLHT851AMedicare PIN