Healthcare Provider Details

I. General information

NPI: 1962580134
Provider Name (Legal Business Name): ADVANCED FOOTCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18280 W DIXIE HWY
MIAMI FL
33160-2001
US

IV. Provider business mailing address

18280 W DIXIE HWY
MIAMI FL
33160-2001
US

V. Phone/Fax

Practice location:
  • Phone: 786-428-3668
  • Fax: 305-932-0923
Mailing address:
  • Phone: 786-428-3668
  • Fax: 305-932-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES A. MUTSCHLER
Title or Position: PRESIDENT/PODIATRIST
Credential: DPM
Phone: 786-428-3668