MEDICARE: OAKWOOD LAKES PODIATRY GROUP PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO 1994	FL

General Provider Information

NPI Number	:	1518082098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKWOOD LAKES PODIATRY GROUP PA

Provider Business Mailing Address
First Line	:	3695 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4516
Country	:	US
Telephone Number	:	561-364-5522
Fax Number	:	561-364-9823

Provider Business Practice Location Address
First Line	:	3695 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4516
Country	:	US
Telephone Number	:	561-364-5522
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRAD S MATTISON
Credential	:
Telephone Number	:	561-364-5522

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	11/04/2008

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1881702223 — DR. DAVID MARK FEINERMAN D.M.D., M.D.
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