MEDICARE: PODIATRY 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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1437336542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY CENTER PA

Provider Business Mailing Address
First Line	:	408 S 1ST ST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4146
Country	:	US
Telephone Number	:	863-676-1710
Fax Number	:	863-676-0025

Provider Business Practice Location Address
First Line	:	408 S 1ST ST
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4146
Country	:	US
Telephone Number	:	863-676-1710
Fax Number	:	863-676-0025

Authorized Official
Title or Position	:	PRES
Name	:	DR. DAVID IRA METZENDORF
Credential	:	DPM
Telephone Number	:	863-293-1968

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	04/20/2008

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