MEDICARE: MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC

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	335E00000X	Prosthetic/Orthotic Supplier		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164420766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC

Provider Business Mailing Address
First Line	:	4990 SW 72ND AVE
Second Line	:	STE 107
City	:	MIAMI
State	:	FL
Zip	:	33155-5524
Country	:	US
Telephone Number	:	954-772-1299
Fax Number	:	954-772-1495

Provider Business Practice Location Address
First Line	:	4990 SW 72ND AVE
Second Line	:	STE 107
City	:	MIAMI
State	:	FL
Zip	:	33155-5524
Country	:	US
Telephone Number	:	954-772-1299
Fax Number	:	954-772-1495

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SILVIO A MARTINEZ
Credential	:	CPO/LPO
Telephone Number	:	954-772-1299

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/30/2021

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