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General NPI Number Information
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NPI Number | 1457197873
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Entity Type | Organization
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Legal Business Name | INNOVATIVE FOOT AND ANKLE SPECIALISTS PLLC
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Dates
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Enumeration Date | 07/04/2024
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 3900 LAKE CENTER DR STE A1
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City | MOUNT DORA
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State | FL
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Zip | 32757-2203
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Country | US
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Telephone | 352-562-7590
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Fax | 352-663-8530
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Provider Business Mailing Address
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Address Line | PO BOX 770754
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City | WINTER GARDEN
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State | FL
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Zip | 34777-0754
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Country | US
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Telephone | 352-744-6290
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Fax |
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Authorized Official
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Title or Position | PODIATRIST, PROVIDER
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Name | DR. KEVIN ALLEN TOOTLE
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Credential | DPM
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Telephone | 352-562-7590
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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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