Healthcare Provider Details

I. General information

NPI: 1346788114
Provider Name (Legal Business Name): APEX FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 PINE RIDGE RD SUITE 102
NAPLES FL
34109-3828
US

IV. Provider business mailing address

9400 GLADIOLUS DR SUITE 300
FORT MYERS FL
33908-6699
US

V. Phone/Fax

Practice location:
  • Phone: 239-433-0064
  • Fax: 239-433-0224
Mailing address:
  • Phone: 239-433-0064
  • Fax: 239-433-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3600
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3600
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLES ROBERT DUSHACK III
Title or Position: CEO
Credential: DPM
Phone: 239-433-0064