=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942974563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARLIS FAMILY FOOT AND ANKLE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2021
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 NW PRIMA VISTA BLVD
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34983-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-210-3339
-----------------------------------------------------
Fax | 772-404-7819
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 NW PRIMA VISTA BLVD
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34983-8731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-210-3339
-----------------------------------------------------
Fax | 772-404-7819
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER/ MANAGING PARTNER
-----------------------------------------------------
Name | DR. MACALEE HARLIS JR.
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 954-330-6049
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------