Provider Demographics
NPI:1598702847
Name:FAMILY FOOT AND LEG CENTER PA
Entity type:Organization
Organization Name:FAMILY FOOT AND LEG CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:KWAN
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-430-3668
Mailing Address - Street 1:730 GOODLETTE RD N STE 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5617
Mailing Address - Country:US
Mailing Address - Phone:239-430-3668
Mailing Address - Fax:239-692-9436
Practice Address - Street 1:730 GOODLETTE RD N STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-430-3668
Practice Address - Fax:239-692-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3169213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118268OtherGREAT WEST
FL5523550001OtherNHIC REGION A
FL611311900OtherDEPARTMENT OF LABOR
FL65898OtherBLUE CROSS BLUE SHIELD
FLK8292OtherMEDICARE
FL290194OtherHEALTHY KIDS
FL5523550001OtherREGION C DMERC
FLK8292Medicare PIN
FL65898OtherBLUE CROSS BLUE SHIELD
FL5523550001Medicare NSC