Healthcare Provider Details

I. General information

NPI: 1396447041
Provider Name (Legal Business Name): ANDREW IMMLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12486 DOGLEG DR
BOYNTON BEACH FL
33437-4122
US

IV. Provider business mailing address

12486 DOGLEG DR
BOYNTON BEACH FL
33437-4122
US

V. Phone/Fax

Practice location:
  • Phone: 561-654-1137
  • Fax:
Mailing address:
  • Phone: 561-654-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: