MEDICARE: PRIMARY FOOT CARE CENTER, 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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2352	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	:	1548461148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY FOOT CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	1100 NE 163RD ST STE 101
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4515
Country	:	US
Telephone Number	:	305-948-8497
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 NE 163RD ST STE 101
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4515
Country	:	US
Telephone Number	:	305-948-8497
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TAMARA DAWN FISHMAN
Credential	:	DPM
Telephone Number	:	305-948-8497

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	05/14/2008

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