MEDICARE: ORLANDO FOOT AND ANKLE CLINIC, INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DB3528	OTHER	FL	R/R MEDICARE

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	:	1295849867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORLANDO FOOT AND ANKLE CLINIC, INC

Provider Business Mailing Address
First Line	:	PO BOX 140233
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-0233
Country	:	US
Telephone Number	:	407-423-1234
Fax Number	:	407-517-1040

Provider Business Practice Location Address
First Line	:	499 E CENTRAL PARKWY
Second Line	:	STE 120
City	:	ALTAMONTE SPRGS
State	:	FL
Zip	:	32701
Country	:	US
Telephone Number	:	407-331-7844
Fax Number	:	407-478-3595

Authorized Official
Title or Position	:	CEO
Name	:	GREGORY RENTON
Credential	:
Telephone Number	:	407-423-1234

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/05/2020

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