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General NPI Number Information
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NPI Number | 1750135166
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Entity Type | Organization
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Legal Business Name | SOUTH FLORIDA FOOT & ANKLE LLC
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Dates
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Enumeration Date | 04/12/2024
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Last Update Date | 04/12/2024
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Provider Practice Location Address
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Address Line | 11020 RCA CENTER DR STE 2004
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4277
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Country | US
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Telephone | 561-676-3611
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Fax |
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Provider Business Mailing Address
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Address Line | 7491 N FEDERAL HWY STE C-5137
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City | BOCA RATON
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State | FL
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Zip | 33487-1625
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Country | US
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Telephone | 561-676-3611
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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. GIANNI PERSICH
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Credential | DPM
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Telephone | 561-676-3611
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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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