Healthcare Provider Details

I. General information

NPI: 1083269955
Provider Name (Legal Business Name): CERTIFIED FOOT & ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JUPITER LAKES BLVD STE A
JUPITER FL
33458-7196
US

IV. Provider business mailing address

1601 CLINT MOORE RD STE 180
BOCA RATON FL
33487-5713
US

V. Phone/Fax

Practice location:
  • Phone: 561-320-9298
  • Fax: 772-288-3341
Mailing address:
  • Phone: 561-995-0229
  • Fax: 561-989-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: KYLE J KINMON
Title or Position: PRESIDENT
Credential: DPM
Phone: 561-995-0229