Healthcare Provider Details

I. General information

NPI: 1750437166
Provider Name (Legal Business Name): FOOT AND ANKLE CARE OF THE ISLAND COAST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13761 MCGREGOR BLVD
FORT MYERS FL
33919-6120
US

IV. Provider business mailing address

13761 MCGREGOR BLVD
FORT MYERS FL
33919-6120
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-7100
  • Fax: 239-482-4209
Mailing address:
  • Phone: 239-482-7100
  • Fax: 239-482-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO-1727
License Number StateFL

VIII. Authorized Official

Name: DR. CURTIS W. SKUPNY
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 239-482-7100