MEDICARE: FOOT DOCTORS OF THE PALM BEACHES, INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77343	OTHER	FL	BC-BS FL

General Provider Information

NPI Number	:	1649349416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT DOCTORS OF THE PALM BEACHES, INC.

Provider Business Mailing Address
First Line	:	1411 N FLAGLER DR STE 6600
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3427
Country	:	US
Telephone Number	:	561-655-1026
Fax Number	:	561-659-7270

Provider Business Practice Location Address
First Line	:	1411 N FLAGLER DR STE 6600
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3427
Country	:	US
Telephone Number	:	561-655-1026
Fax Number	:	561-659-7270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH A HAMBERG
Credential	:	D.P.M.
Telephone Number	:	561-655-1026

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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