Healthcare Provider Details

I. General information

NPI: 1275721680
Provider Name (Legal Business Name): SOUTHERNMOST FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 OVERSEAS HWY
MARATHON FL
33050-2239
US

IV. Provider business mailing address

975 BAPTIST WAY #101
HOMESTEAD FL
33033-7600
US

V. Phone/Fax

Practice location:
  • Phone: 305-242-6494
  • Fax:
Mailing address:
  • Phone: 305-246-4774
  • Fax: 305-248-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY MAKIMAA
Title or Position: PHYSICIAN
Credential: DPM,FACFAS
Phone: 305-246-4774