Provider Demographics
NPI:1124066279
Name:DELRAY PODIATRY FOOT & ANKLE GROUP, INC.
Entity type:Organization
Organization Name:DELRAY PODIATRY FOOT & ANKLE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-865-3331
Mailing Address - Street 1:13590 JOG RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-865-3331
Mailing Address - Fax:561-865-3332
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE 2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-865-3331
Practice Address - Fax:561-865-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2035213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4252480001Medicare NSC
FLK3506Medicare ID - Type UnspecifiedGROUP PORVIDER NUMBER