Healthcare Provider Details

I. General information

NPI: 1215439740
Provider Name (Legal Business Name): PALM TREE LOWER EXTREMITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CARILLON PKWY UNIT 509
SAINT PETERSBURG FL
33716-1402
US

IV. Provider business mailing address

250 CARILLON PKWY UNIT 509
SAINT PETERSBURG FL
33716-1402
US

V. Phone/Fax

Practice location:
  • Phone: 973-986-5926
  • Fax:
Mailing address:
  • Phone: 973-986-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ABIOLA J. OKI
Title or Position: OWNER
Credential: DPM
Phone: 973-973-5926