MEDICARE: HOME PODIATRY GROUP PLLC

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

General Provider Information

NPI Number	:	1396692562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME PODIATRY GROUP PLLC

Provider Business Mailing Address
First Line	:	12486 DOGLEG DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-4122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12486 DOGLEG DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-4122
Country	:	US
Telephone Number	:	561-654-1137
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW IMMLER
Credential	:	DPM
Telephone Number	:	561-654-1137

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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