Provider Demographics
NPI:1881295079
Name:PARDEE FOOT CLINIC
Entity type:Organization
Organization Name:PARDEE FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-778-2190
Mailing Address - Street 1:1808 W INTERNATIONAL SPEEDWAY BLVD STE 304A
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1227
Mailing Address - Country:US
Mailing Address - Phone:734-778-2190
Mailing Address - Fax:
Practice Address - Street 1:1808 W INTERNATIONAL SPEEDWAY BLVD STE 304A
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1227
Practice Address - Country:US
Practice Address - Phone:734-778-2190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARDEE FOOT CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty