MEDICARE: APPLE DIABETIC SHOES, 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	332B00000X	Durable Medical Equipment & Medical Supplies	PED37	FL

General Provider Information

NPI Number	:	1790890127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLE DIABETIC SHOES, INC.

Provider Business Mailing Address
First Line	:	7775 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2536
Country	:	US
Telephone Number	:	877-277-5313
Fax Number	:	561-964-1091

Provider Business Practice Location Address
First Line	:	7775 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2536
Country	:	US
Telephone Number	:	877-277-5313
Fax Number	:	561-964-1091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PETER ARENA
Credential	:	C.PED.
Telephone Number	:	877-277-5313

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/22/2020

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