Unknown Individual – Foot Surgery Podiatrist, NPI 1134118441

Unknown Individual is a healthcare provider. based in Jacksonville, Florida. specializing in Foot Surgery Podiatrist. They hold a License No. PO463 (FL). The NPI Number for Unknown Individual is 1134118441

Main info

Organization
Inactive
57 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1134118441
Phone
(904) 725-2121
Address
1808 UNIVERSITY BLVD S
Deactivation Date
10 June 2021

Doctor Profile

Medical School Name
KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
Secondary Phone
9047252121
Graduation Year
1969 (57 years ago)
PAC ID
3779611934
Professional Enrollment ID
I20100507000588
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1808, University Boulevard South, Jacksonville, Duval County, Florida, 32216, United States

    JACKSONVILLE, FL 322168931

    Phone: (904) 725-2121

    Fax: (904) 724-2450

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32216)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1134118441 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Foot Surgery Podiatrist in this dataset. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Jacksonville, Florida in the data we show; additional addresses may exist on the full record.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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