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General NPI Number Information
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NPI Number | 1447462601
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Entity Type | Organization
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Legal Business Name | DOCTORS FOOT CARE GROUP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 111 WILLARD ST SUITE 2F
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City | QUINCY
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State | MA
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Zip | 02169-1200
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Country | US
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Telephone | 617-773-2313
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Fax |
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Provider Business Mailing Address
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Address Line | 111 WILLARD ST SUITE 2F
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City | QUINCY
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State | MA
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Zip | 02169-1200
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Country | US
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Telephone | 617-773-2313
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WYNN ADAM PERLICK
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Credential | D.P.M.
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Telephone | 617-773-2313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 2053
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License Number State | MA
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