MEDICARE: CERTIFIED FOOT & ANKLE SPECIALISTS

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
2	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1538766738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED FOOT & ANKLE SPECIALISTS

Provider Business Mailing Address
First Line	:	1601 CLINT MOORE RD STE 180
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-5713
Country	:	US
Telephone Number	:	561-995-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 N FEDERAL HWY STE 405
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-1414
Country	:	US
Telephone Number	:	954-771-5900
Fax Number	:	954-771-5959

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KYLE J KINMON
Credential	:	MD
Telephone Number	:	561-995-0229

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/09/2024

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Directions to “CERTIFIED FOOT & ANKLE SPECIALISTS ” Practice Location

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