MEDICARE: INNOVATIVE DURABLE MEDICAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1003431131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE DURABLE MEDICAL, LLC

Provider Business Mailing Address
First Line	:	16400 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4115
Country	:	US
Telephone Number	:	305-864-1373
Fax Number	:	305-868-3124

Provider Business Practice Location Address
First Line	:	16400 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4115
Country	:	US
Telephone Number	:	305-864-1373
Fax Number	:	305-868-3124

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DMITRY SANDLER
Credential	:	DPM
Telephone Number	:	305-864-1373

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	05/14/2021

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