Provider Demographics
NPI:1649349416
Name:FOOT DOCTORS OF THE PALM BEACHES, INC.
Entity type:Organization
Organization Name:FOOT DOCTORS OF THE PALM BEACHES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-655-1026
Mailing Address - Street 1:1411 N FLAGLER DR STE 6600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3427
Mailing Address - Country:US
Mailing Address - Phone:561-655-1026
Mailing Address - Fax:561-659-7270
Practice Address - Street 1:1411 N FLAGLER DR STE 6600
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3427
Practice Address - Country:US
Practice Address - Phone:561-655-1026
Practice Address - Fax:561-659-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77343OtherBC-BS FL
FL77343OtherBC-BS FL