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General NPI Number Information
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NPI Number | 1194116343
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FOOT AND ANKLE LLC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 100 CENTURY BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33417-2262
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Country | US
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Telephone | 561-293-3439
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Fax | 561-689-1844
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Provider Business Mailing Address
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Address Line | 900 OSCEOLA DR STE 201
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-5075
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Country | US
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Telephone | 561-293-3439
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Fax | 561-689-1844
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Authorized Official
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Title or Position | PODIATRIST
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Name | DANIEL J PERO
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Credential | DPM
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Telephone | 561-293-3439
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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 | FD1702
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3394
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License Number State | FL
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