Healthcare Provider Details

I. General information

NPI: 1205256617
Provider Name (Legal Business Name): GOLDENFEET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 PALM COAST PKWY NW UNIT 4
PALM COAST FL
32137-3677
US

IV. Provider business mailing address

4877 PALM COAST PKWY NW UNIT 4
PALM COAST FL
32137-3677
US

V. Phone/Fax

Practice location:
  • Phone: 386-490-9990
  • Fax: 386-263-8768
Mailing address:
  • Phone: 386-490-9990
  • Fax: 386-263-8768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: JOE LI
Title or Position: PRESIDENT
Credential: DPM
Phone: 386-490-9990