Basic Information
| Provider Information | |||||||||
| NPI: | 1437552148 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANKLE & FOOT CENTER OF LAKE COUNTY LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ANKLE & FOOT CENTER OF CENTRAL FLORIDA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1865 NIGHTINGALE LN STE A | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327784360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523857718 | ||||||||
| FaxNumber: | 3523857719 | ||||||||
| Practice Location | |||||||||
| Address1: | 1865 NIGHTINGALE LN STE A | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327784360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523857718 | ||||||||
| FaxNumber: | 3523857719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2014 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | BALKARAN | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3523857718 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | PO3337 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.