# LAKE WALES FOOT AND ANKLE CARE, INC

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

## Provider details

- **NPI number:** 1770930919
- **Authorized official:** DR. PRERNA ALFA MALL DPM (PRESIDENT)
- **Authorized official phone:** (863) 676-1710

## Contact information

- **Practice address:** 408 S 1ST ST, HIGHLAND MEADOWS, LAKE WALES, FL 33853-4146
- **Practice address phone:** (863) 676-1710
- **Mailing address:** 801 WOODLARK DR, HIGHLAND MEADOWS, HAINES CITY, FL 33844-7745
- **Mailing address phone:** (863) 676-1710

## Taxonomy

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

## Other

- **Enumeration date:** 05/18/2016
- **Last updated:** 09/26/2016