Provider Demographics
NPI:1861275331
Name:PAT FOOT & ANKLE SURGICAL SPECIALIST LLC
Entity type:Organization
Organization Name:PAT FOOT & ANKLE SURGICAL SPECIALIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:POONEH
Authorized Official - Middle Name:ALAEI
Authorized Official - Last Name:TALEGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-643-8641
Mailing Address - Street 1:1 NE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3402
Mailing Address - Country:US
Mailing Address - Phone:305-432-9565
Mailing Address - Fax:305-432-9567
Practice Address - Street 1:1 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3402
Practice Address - Country:US
Practice Address - Phone:305-432-9565
Practice Address - Fax:305-432-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty