Provider Demographics
NPI:1063920338
Name:KNOCK YOUR SOCKS OFF FOOT & ANKLE SPECIALIST LLC
Entity type:Organization
Organization Name:KNOCK YOUR SOCKS OFF FOOT & ANKLE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-914-1223
Mailing Address - Street 1:19421 NE 18TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3655
Mailing Address - Country:US
Mailing Address - Phone:510-914-1223
Mailing Address - Fax:786-657-2758
Practice Address - Street 1:150 NW 168TH ST STE 303
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6051
Practice Address - Country:US
Practice Address - Phone:786-298-5861
Practice Address - Fax:786-657-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3966213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty