Organization
ADVANCED AGILITY FOOT & ANKLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MARTINCEVIC DPM (OWNER)
(405) 227-8453
Entity
Organization
Contact information
Practice address
1151 MIRANDA LN, KISSIMMEE, FL 34741-0763
(405) 227-8453
(407) 483-4139
Mailing address
3001 LANGDON LN N, KISSIMMEE, FL 34741-7714
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3871
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5T5J9
FLORIDA BLUE
FL
Enumeration date
05/22/2018
Last updated
05/22/2018
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