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General NPI Number Information
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NPI Number | 1003365107
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Entity Type | Organization
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Legal Business Name | MODERN FOOT AND ANKLE, PLLC
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Dates
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Enumeration Date | 09/29/2016
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 1005 DALE MABRY HIGHWAY
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City | LUTZ
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State | FL
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Zip | 33548-3021
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Country | US
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Telephone | 813-549-5678
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Fax | 813-701-9132
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Provider Business Mailing Address
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Address Line | 1005 DALE MABRY HWY
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City | LUTZ
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State | FL
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Zip | 33548-3021
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM SIEGEL
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Credential | DPM
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Telephone | 813-549-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3831
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License Number State | FL
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