Provider Demographics
NPI:1750135166
Name:SOUTH FLORIDA FOOT & ANKLE LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-676-3611
Mailing Address - Street 1:7491 N FEDERAL HWY STE C-5137
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1625
Mailing Address - Country:US
Mailing Address - Phone:561-676-3611
Mailing Address - Fax:
Practice Address - Street 1:11020 RCA CENTER DR STE 2004
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4277
Practice Address - Country:US
Practice Address - Phone:561-676-3611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty