MEDICARE: BOYNTON HOME FOOT CARE, LLC

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	261QP1100X	Podiatric Clinic/Center	PO 3561	FL

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	:	1528122215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYNTON HOME FOOT CARE, LLC

Provider Business Mailing Address
First Line	:	202 ASBURY WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5535
Country	:	US
Telephone Number	:	561-509-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 ASBURY WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5535
Country	:	US
Telephone Number	:	561-509-9087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN LEE FRIEDMAN
Credential	:	DPM
Telephone Number	:	561-509-9087

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	08/16/2013

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