MEDICARE: FAMILY FOOT AND LEG CENTER 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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1417828401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY FOOT AND LEG CENTER PA

Provider Business Mailing Address
First Line	:	730 GOODLETTE RD STE 102
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34102-5617
Country	:	US
Telephone Number	:	239-430-3668
Fax Number	:	239-692-9436

Provider Business Practice Location Address
First Line	:	6846 INTERNATIONAL CENTER BLVD # B
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7155
Country	:	US
Telephone Number	:	239-430-3668
Fax Number	:	239-692-9436

Authorized Official
Title or Position	:	OWNER
Name	:	KEVIN KWAN LAM
Credential	:	DPM
Telephone Number	:	239-430-3668

Provider Enumeration Date	:	09/15/2025
Last Update Date	:	09/15/2025

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