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General NPI Number Information
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NPI Number | 1063607950
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Entity Type | Organization
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Legal Business Name | PODIATRY ASSOCIATES OF THE PALM BEACHES LLC
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 11/05/2007
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Provider Practice Location Address
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Address Line | 8190 OKEECHOBEE BLVD SUITE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33411-2047
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Country | US
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Telephone | 561-358-6054
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Fax | 561-848-1940
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Provider Business Mailing Address
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Address Line | 1616 39TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-3634
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Country | US
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Telephone | 786-271-7688
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Fax | 561-848-1940
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DR. KALI MELISSA ETHEREDGE
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Credential | DPM
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Telephone | 786-271-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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