Provider Demographics
NPI:1639051196
Name:ELITE PODIATRY & SURGICAL INSTITUTE INC
Entity type:Organization
Organization Name:ELITE PODIATRY & SURGICAL INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CREDENTIALING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-948-0004
Mailing Address - Street 1:660 PALM SPRINGS DR STE D
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7864
Mailing Address - Country:US
Mailing Address - Phone:407-948-0004
Mailing Address - Fax:
Practice Address - Street 1:660 PALM SPRINGS DR STE D
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-7864
Practice Address - Country:US
Practice Address - Phone:407-948-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty