Healthcare Provider Details

I. General information

NPI: 1770136061
Provider Name (Legal Business Name): OLUPONA FOOT AND ANKLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W 41ST ST
MIAMI BEACH FL
33140-3603
US

IV. Provider business mailing address

2601 SW 37TH AVE STE 904
MIAMI FL
33133-2751
US

V. Phone/Fax

Practice location:
  • Phone: 305-535-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: BAMIDELE OLUGBENGA OLUPONA
Title or Position: OWNER
Credential:
Phone: 202-321-8812