Healthcare Provider Details

I. General information

NPI: 1386910305
Provider Name (Legal Business Name): INTEGRATIVE FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2012
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 OKEECHOBEE BLVD #303
WEST PALM BEACH FL
33417
US

IV. Provider business mailing address

5405 OKEECHOBEE BLVD #303
WEST PALM BEACH FL
33417
US

V. Phone/Fax

Practice location:
  • Phone: 561-293-3439
  • Fax: 561-689-1844
Mailing address:
  • Phone: 561-293-3439
  • Fax: 561-689-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3608
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3394
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3394
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3608
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3394
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL J PERO
Title or Position: OWNER
Credential: DPM
Phone: 586-873-8913