Healthcare Provider Details

I. General information

NPI: 1669468229
Provider Name (Legal Business Name): SAMIR S VAKIL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

352 MILUS ST
PUNTA GORDA FL
33950-4552
US

IV. Provider business mailing address

PO BOX 511269
PUNTA GORDA FL
33951-1269
US

V. Phone/Fax

Practice location:
  • Phone: 941-639-0025
  • Fax: 941-374-7271
Mailing address:
  • Phone: 941-639-0025
  • Fax: 941-347-7271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO002258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: