Provider Demographics
NPI:1053772921
Name:ADVANCED FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ROMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-863-4757
Mailing Address - Street 1:178 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-5352
Mailing Address - Country:US
Mailing Address - Phone:407-671-8010
Mailing Address - Fax:407-671-4155
Practice Address - Street 1:178 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5352
Practice Address - Country:US
Practice Address - Phone:407-671-8010
Practice Address - Fax:407-671-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3710213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty