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General NPI Number Information
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NPI Number | 1063920338
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Entity Type | Organization
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Legal Business Name | KNOCK YOUR SOCKS OFF FOOT & ANKLE SPECIALIST LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 150 NW 168TH ST STE 303
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-6051
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Country | US
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Telephone | 786-298-5861
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Fax | 786-657-2758
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Provider Business Mailing Address
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Address Line | 19421 NE 18TH CT
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33179-3655
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Country | US
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Telephone | 510-914-1223
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Fax | 786-657-2758
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL NORRIS
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Credential | DPM
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Telephone | 510-914-1223
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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 | PO3966
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License Number State | FL
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