MEDICARE: DR. BRIAN PAVLAS DPM

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	213E00000X	Podiatrist	PO3232	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

General Provider Information

NPI Number	:	1982659710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN PAVLAS DPM

Provider Business Mailing Address
First Line	:	4821 SW 64TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6105
Country	:	US
Telephone Number	:	786-999-4840
Fax Number	:	305-356-7150

Provider Business Practice Location Address
First Line	:	4821 SW 64TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6105
Country	:	US
Telephone Number	:	786-999-4840
Fax Number	:	305-356-7150

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/16/2021

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