Healthcare Provider Details

I. General information

NPI: 1033654413
Provider Name (Legal Business Name): GULFCOAST FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24231 WALDEN CENTER DR STE 120
ESTERO FL
34134-5011
US

IV. Provider business mailing address

PO BOX 110759
NAPLES FL
34108-0113
US

V. Phone/Fax

Practice location:
  • Phone: 239-949-3399
  • Fax: 239-949-6553
Mailing address:
  • Phone: 239-566-8800
  • Fax: 239-665-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: APRIL MAVROGEORGE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 239-566-8800