Organization
MODERN FOOT AND ANKLE, PLLC
Active
Other names
Modern Foot and Ankle
Organization subpart
No
Provider details
NPI number
Authorized official
ADAM SIEGEL DPM (OWNER)
(813) 549-5678
Entity
Organization
Contact information
Practice address
1005 DALE MABRY HIGHWAY, LUTZ, FL 33548-3021
(813) 549-5678
(813) 701-9132
Mailing address
1005 DALE MABRY HWY, LUTZ, FL 33548-3021
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019557100
—
FL
Enumeration date
09/29/2016
Last updated
07/12/2017
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