Healthcare Provider Details

I. General information

NPI: 1346795267
Provider Name (Legal Business Name): FLORIDA CENTER FOR FOOT AND ANKLE DISORDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2016
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N MIAMI BEACH BLVD STE 502
NORTH MIAMI BEACH FL
33162-3712
US

IV. Provider business mailing address

909 N MIAMI BEACH BLVD STE 502
NORTH MIAMI BEACH FL
33162-3712
US

V. Phone/Fax

Practice location:
  • Phone: 786-657-2757
  • Fax: 786-657-2758
Mailing address:
  • Phone: 786-657-2757
  • Fax: 786-657-2758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KASRA S KAGHAZCHI
Title or Position: OWNER
Credential: DPM
Phone: 786-657-2757