Basic Information
| Provider Information | |||||||||
| NPI: | 1821557596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEGALL FOOT & ANKLE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 NW 82ND AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333241853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543842555 | ||||||||
| FaxNumber: | 9549005646 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 NE 20TH TER STE 303 | ||||||||
| Address2: | |||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333084510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547718177 | ||||||||
| FaxNumber: | 9547713629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2019 | ||||||||
| LastUpdateDate: | 03/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | FENELON | ||||||||
| AuthorizedOfficialFirstName: | BRIGIDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9547718177 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 65268 | 01 | FL | BCBS FL | OTHER |