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General NPI Number Information
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NPI Number | 1639051196
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Entity Type | Organization
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Legal Business Name | ELITE PODIATRY & SURGICAL INSTITUTE INC
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 660 PALM SPRINGS DR STE D
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7864
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Country | US
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Telephone | 407-948-0004
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Fax |
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Provider Business Mailing Address
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Address Line | 660 PALM SPRINGS DR STE D
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-7864
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Country | US
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Telephone | 407-948-0004
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE CREDENTIALING MANAGER
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Name | MR. ANTOINE WATTS
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Credential |
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Telephone | 407-948-0004
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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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