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General NPI Number Information
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NPI Number | 1942006275
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Entity Type | Organization
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Legal Business Name | FTG ORTHO PLLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 2627 NE 203RD ST STE 100
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City | AVENTURA
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State | FL
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Zip | 33180-1945
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Country | US
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Telephone | 305-937-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 2627 NE 203RD ST STE 100
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City | AVENTURA
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State | FL
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Zip | 33180-1945
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Country | US
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Telephone | 305-937-1999
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DOMINIC J LEWIS
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Credential | MD
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Telephone | 305-937-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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