MEDICARE: DR. WARREN W WINDRAM D.P.M.

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	PO2164	FL

General Provider Information

NPI Number	:	1407819949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WARREN W WINDRAM D.P.M.

Provider Business Mailing Address
First Line	:	1700 NW 49TH ST STE 125
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-3750
Country	:	US
Telephone Number	:	954-767-5214
Fax Number	:	954-767-5222

Provider Business Practice Location Address
First Line	:	1601 S ANDREWS AVE FL 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2509
Country	:	US
Telephone Number	:	954-767-5214
Fax Number	:	954-767-5222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	04/03/2024

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