MEDICARE: BROWARD FOOT AND ANKLE SPECIALIST P A

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790046290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWARD FOOT AND ANKLE SPECIALIST P A

Provider Business Mailing Address
First Line	:	2205 BAY DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-2912
Country	:	US
Telephone Number	:	917-582-4010
Fax Number	:	718-766-8606

Provider Business Practice Location Address
First Line	:	2205 BAY DR
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-2912
Country	:	US
Telephone Number	:	917-582-4010
Fax Number	:	718-766-8606

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EFROSINI FOTOPOULOS
Credential	:	DPM
Telephone Number	:	917-582-4010

Provider Enumeration Date	:	06/01/2012
Last Update Date	:	10/03/2019

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