Healthcare Provider Details

I. General information

NPI: 1437439791
Provider Name (Legal Business Name): HIALEAH FOOT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE SUITE # 53
HIALEAH FL
33012-7194
US

IV. Provider business mailing address

4410 W 16TH AVE SUITE # 53
HIALEAH FL
33012-7194
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-7437
  • Fax: 305-558-1881
Mailing address:
  • Phone: 305-558-7437
  • Fax: 305-558-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1534
License Number StateFL

VIII. Authorized Official

Name: LUIS EIBER
Title or Position: DOCTOR
Credential: DPM
Phone: 305-558-7437