Provider Demographics
NPI:1962580134
Name:ADVANCED FOOTCARE INC
Entity type:Organization
Organization Name:ADVANCED FOOTCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUTSCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-428-3668
Mailing Address - Street 1:18280 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2001
Mailing Address - Country:US
Mailing Address - Phone:786-428-3668
Mailing Address - Fax:305-932-0923
Practice Address - Street 1:18280 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33160-2001
Practice Address - Country:US
Practice Address - Phone:786-428-3668
Practice Address - Fax:305-932-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34386OtherBCBS
FL34386OtherBCBS
FLK3658Medicare PIN