Provider Demographics
NPI:1457197873
Name:INNOVATIVE FOOT AND ANKLE SPECIALISTS PLLC
Entity type:Organization
Organization Name:INNOVATIVE FOOT AND ANKLE SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TOOTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:352-562-7590
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:352-744-6290
Mailing Address - Fax:
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:352-562-7590
Practice Address - Fax:352-663-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-04
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty