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General NPI Number Information
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NPI Number | 1023468295
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Entity Type | Individual
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Provider Name | KEVIN ALLEN TOOTLE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 3900 LAKE CENTER DR STE A1
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City | MOUNT DORA
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State | FL
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Zip | 32757-2203
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Country | US
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Telephone | 525-627-5903
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Fax | 352-663-8530
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Provider Business Mailing Address
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Address Line | PO BOX 770754
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City | WINTER GARDEN
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State | FL
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Zip | 34777-0754
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Country | US
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Telephone | 352-562-7590
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Fax | 352-663-8530
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PO4048
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License Number State | FL
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