Healthcare Provider Details

I. General information

NPI: 1366570913
Provider Name (Legal Business Name): SEGALL FOOT & ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NW 82ND AVE STE 102
PLANTATION FL
33324-1853
US

IV. Provider business mailing address

201 NW 82ND AVE STE 102
PLANTATION FL
33324-1853
US

V. Phone/Fax

Practice location:
  • Phone: 954-384-2555
  • Fax: 954-900-5646
Mailing address:
  • Phone: 954-384-2555
  • Fax: 954-900-5646

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: BRIGIDA FENELON
Title or Position: OFFICE MANAGER
Credential: CPC
Phone: 954-451-3010