Basic Information
| Provider Information | |||||||||
| NPI: | 1528547056 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADM ORTHOPAEDIC FOOT & ANKLE SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 S HARBOR CITY BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329011901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213457579 | ||||||||
| FaxNumber: | 3213272494 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 S HARBOR CITY BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329011901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213457579 | ||||||||
| FaxNumber: | 3213272494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2018 | ||||||||
| LastUpdateDate: | 08/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | WADE | ||||||||
| AuthorizedOfficialFirstName: | ALLISON | ||||||||
| AuthorizedOfficialMiddleName: | MUIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7726311741 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME106167 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.