Healthcare Provider Details

I. General information

NPI: 1558752709
Provider Name (Legal Business Name): INTEGRATIVE FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MILITARY TRL SUITE 110
JUPITER FL
33458-4810
US

IV. Provider business mailing address

900 OSCEOLA DR STE 201
WEST PALM BEACH FL
33409-5075
US

V. Phone/Fax

Practice location:
  • Phone: 561-293-3439
  • Fax: 561-689-1844
Mailing address:
  • Phone: 561-293-3439
  • Fax: 561-689-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3394
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberFD1702
License Number StateFL

VIII. Authorized Official

Name: KARL H MICHEL
Title or Position: PODIATRIST
Credential: DPM
Phone: 561-293-3439