MEDICARE: FOOT & ANKLE CARE 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	261QP1100X	Podiatric Clinic/Center	PO2435	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DH1805	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	65364	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1962499285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE CARE CENTER PA

Provider Business Mailing Address
First Line	:	28089 VANDERBILT DR
Second Line	:	SUITE 104
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7521
Country	:	US
Telephone Number	:	239-498-1176
Fax Number	:	239-498-5877

Provider Business Practice Location Address
First Line	:	28089 VANDERBILT DR
Second Line	:	SUITE 104
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-7521
Country	:	US
Telephone Number	:	239-498-1176
Fax Number	:	239-498-5877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHRISTOPHER PALADINO
Credential	:	DPM
Telephone Number	:	239-498-1176

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	09/17/2010

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Directions to “FOOT & ANKLE CARE CENTER PA ” Practice Location

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