Modern Foot and Ankle, PLLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO3831 Issued in FL

Legal business name

MODERN FOOT AND ANKLE, PLLC

Practice address

1005 Dale Mabry Highway
Lutz, FL 33548-3021

Phone

(813) 549-5678

Fax

(813) 701-9132

NPI assigned

Sep 29, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Adam Siegel, DPM

Title

Owner

Phone

(813) 549-5678

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Modern Foot and Ankle Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1475107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499817600000",
    "number": "1003365107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 DALE MABRY HWY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 DALE MABRY HIGHWAY",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335483021",
            "telephone_number": "813-549-5678",
            "fax_number": "813-701-9132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN FOOT AND ANKLE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-29",
        "last_updated": "2017-07-12",
        "status": "A",
        "authorized_official_last_name": "SIEGEL",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-549-5678",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO3831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019557100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modern Foot and Ankle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Foot & Ankle Surgery Podiatrist in Lutz, FL
• Providers in Lutz, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.