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General NPI Number Information
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NPI Number | 1578905550
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE FOOT AND ANKLE SPECIALISTS OF COLLIER
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 07/19/2013
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Provider Practice Location Address
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Address Line | 2500 TAMIAMI TRL N 206
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City | NAPLES
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State | FL
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Zip | 34103-4470
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Country | US
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Telephone | 239-331-7144
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Fax |
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Provider Business Mailing Address
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Address Line | 8340 COLLIER BLVD 400
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City | NAPLES
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State | FL
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Zip | 34114-3625
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Country | US
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Telephone | 239-331-7144
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. LOAN LAM VON DER LANCKEN
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Credential | DPM
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Telephone | 239-331-7144
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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 | PO3302
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License Number State | FL
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