Provider Demographics
NPI:1679376065
Name:MAINE FOOT ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:MAINE FOOT ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULES
Authorized Official - Middle Name:BEATRIX
Authorized Official - Last Name:BODO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-521-6107
Mailing Address - Street 1:12 CYPRUS HILL DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4898
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2373
Practice Address - Country:US
Practice Address - Phone:207-521-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty