MEDICARE: FOOT & ANKLE GROUP OF SOUTHWEST FLORIDA, PA

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
2	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-1326	FL
3	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-2020	FL
4	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-1693	FL
5	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-3722	FL
6	261QP1100X	Podiatric Clinic/Center
7	213ES0103X	Foot & Ankle Surgery Podiatrist	PO-3613	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN1511	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1194725002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE GROUP OF SOUTHWEST FLORIDA, PA

Provider Business Mailing Address
First Line	:	7117 CONGDON RD APT 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5004
Country	:	US
Telephone Number	:	239-936-5400
Fax Number	:	239-936-9572

Provider Business Practice Location Address
First Line	:	7117 CONGDON RD APT 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-5004
Country	:	US
Telephone Number	:	239-936-5400
Fax Number	:	239-936-9572

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	JEROLD S. GOLDSTEIN
Credential	:
Telephone Number	:	239-936-5400

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	05/01/2025

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