MEDICARE: FAMILY PODIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO 2501	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134408164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PODIATRY

Provider Business Mailing Address
First Line	:	500 NW 43D ST.
Second Line	:	2
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-6126
Country	:	US
Telephone Number	:	352-376-5112
Fax Number	:	352-376-0320

Provider Business Practice Location Address
First Line	:	500 NW 43RD ST
Second Line	:	SUITE 2
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-6126
Country	:	US
Telephone Number	:	352-376-5112
Fax Number	:	352-376-0320

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT KOPPEL
Credential	:	DPM
Telephone Number	:	352-376-5112

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	06/04/2014

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Directions to “FAMILY PODIATRY ” Practice Location

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