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General NPI Number Information
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NPI Number | 1194664953
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Entity Type | Organization
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Legal Business Name | ADVANCED INNOVATIONS PODIATRY LLC
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Dates
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Enumeration Date | 03/26/2026
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Last Update Date | 03/26/2026
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Provider Practice Location Address
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Address Line | 1700 WATERFORD DR
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City | VERO BEACH
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State | FL
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Zip | 32966-8043
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Country | US
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Telephone | 772-275-4923
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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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 | AUTHORIZED SIGNER
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Name | FORTON WIMBUSH
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Credential |
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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 |
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License Number State |
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