# PODIATRY GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760151088
- **Authorized official:** BAMIDELE O OLUPONA DPM (CEO)
- **Authorized official phone:** (202) 321-8812

## Contact information

- **Practice address:** 2400 SW 69TH AVENUE, SUITE 140, MIAMI, FL 33155
- **Practice address phone:** (305) 450-1757
- **Practice address fax:** (305) 265-4844
- **Mailing address:** 2400 SW 69TH AVENUE, SUITE 140, MIAMI, FL 33155
- **Mailing address phone:** (305) 450-1757
- **Mailing address fax:** (305) 265-4844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | NULL | — |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |
| 213ES0131X | Foot Surgery Podiatrist | — | NULL | — |
| 213ES0131X | Foot Surgery Podiatrist | — | — | — |

## Other

- **Enumeration date:** 09/09/2021
- **Last updated:** 09/09/2021