Provider Demographics
NPI:1700339108
Name:AXEL PODIATRY SERVICES LLC
Entity Type:Organization
Organization Name:AXEL PODIATRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:239-872-9734
Mailing Address - Street 1:4820 GRIFFIN BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-2016
Mailing Address - Country:US
Mailing Address - Phone:239-313-2901
Mailing Address - Fax:
Practice Address - Street 1:3050 CHAMPION RING RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5599
Practice Address - Country:US
Practice Address - Phone:561-869-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXEL HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-02
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty