Provider Demographics
NPI:1952981656
Name:ISLAND FOOT AND ANKLE SURGERY
Entity Type:Organization
Organization Name:ISLAND FOOT AND ANKLE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:YUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-212-7678
Mailing Address - Street 1:35 BILL FRIES DR BLDG L
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2797
Mailing Address - Country:US
Mailing Address - Phone:843-895-2140
Mailing Address - Fax:843-895-2141
Practice Address - Street 1:35 BILL FRIES DR BLDG L
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2797
Practice Address - Country:US
Practice Address - Phone:248-212-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821037037Medicaid