Organization
FOOT AND ANKLE CENTER OF SOUTHERN MAINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J MICCA DPM (OWNER)
(207) 985-9888
Entity
Organization
Contact information
Practice address
75 PORTLAND RD, KENNEBUNK, ME 04043-6602
(207) 985-9888
(207) 985-3488
Mailing address
75 PORTLAND RD, KENNEBUNK, ME 04043-6602
(207) 985-9888
(207) 985-3488
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133240000
—
ME
Enumeration date
01/10/2008
Last updated
06/30/2008
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