Healthcare Provider Details

I. General information

NPI: 1750135166
Provider Name (Legal Business Name): SOUTH FLORIDA FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11020 RCA CENTER DR STE 2004
PALM BEACH GARDENS FL
33410-4277
US

IV. Provider business mailing address

7491 N FEDERAL HWY STE C-5137
BOCA RATON FL
33487-1625
US

V. Phone/Fax

Practice location:
  • Phone: 561-676-3611
  • Fax:
Mailing address:
  • Phone: 561-676-3611
  • Fax:

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: DR. GIANNI PERSICH
Title or Position: CEO
Credential: DPM
Phone: 561-676-3611