Unknown Individual – Foot & Ankle Surgery Podiatrist, NPI 1770664401

Foot & Ankle Surgery Podiatrist

Unknown Individual is a healthcare provider. based in Miami beach, Florida. specializing in Foot & Ankle Surgery Podiatrist. They hold a License No. PO0831 (FL). The NPI Number for Unknown Individual is 1770664401

Main info

Organization

Inactive

53 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1770664401

Phone

(305) 672-2666

Address

4302 ALTON ROAD SUITE 1005

Deactivation Date

23 June 2023

Doctor Profile

Medical School Name

KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE

Secondary Phone

3056722666

Graduation Year

1973 (53 years ago)

PAC ID

6002872785

Group Practice PAC ID

8628173465

Professional Enrollment ID

I20070424000643

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

Provider Addresses for Unknown Individual

4302 ALTON ROAD SUITE 1005
MOUNT SINAI MEDICAL CENTER SIMON BUILDING
MIAMI BEACH, FL 331402890
Phone: (305) 672-2666
Fax: (305) 534-1854
Type: Location
27, Gatlin Street, Doral Acres, Lynchburg, Virginia, 24502, United States
STE 108
DORAL, FL 331221906
Phone: (786) 662-3893
Fax: (786) 662-3899
Type: Mailing

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.

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Medicare Enrollment & Revalidation

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

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

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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 33140)

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Provider's Procedures

Unknown Individual performs procedures in Foot & Ankle Surgery Podiatrist. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
PODIATRY	FL	11042	Removal of skin and tissue first 20 sq cm or less	112	19
PODIATRY	FL	76942	Ultrasonic guidance imaging supervision and interpretation for insertion of needle	30	25

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 8628173465View full group profile

Name	Specialty	State
MR. MICHAEL R COOK (D.P.M.)	P O D I A T R Y	FL
DR. THOMAS GERARD ZWICK (D.P.M.)	P O D I A T R Y	FL
DR. MICHAEL DANIEL PAULA (DPM)	P O D I A T R Y	FL
DR. JULIE SCHOTTENSTEIN (DPM)	P O D I A T R Y	FL
ELBYS ERA (DPM)	P O D I A T R Y	FL
DR. LAURENCE SETH LEDER (DPM)	P O D I A T R Y	FL
DR. KATHERINE MACHADO (DPM)	P O D I A T R Y	FL
LYDIANN ANTOMMATTEI-SEDA (DPM)	P O D I A T R Y	FL
JUAN GABRIEL DIAZ-HERNANDEZ (DPM)	P O D I A T R Y	FL
DR. EDWARD A BUSTAMANTE (DPM)	P O D I A T R Y	FL