Healthcare Provider Details

I. General information

NPI: 1972612927
Provider Name (Legal Business Name): MEBERG & COHEN LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N WICKHAM RD SUITE 103
MELBOURNE FL
32940
US

IV. Provider business mailing address

7730 N WICKHAM RD SUITE 103
MELBOURNE FL
32940
US

V. Phone/Fax

Practice location:
  • Phone: 321-253-3595
  • Fax: 321-253-3596
Mailing address:
  • Phone: 321-253-3595
  • Fax: 321-253-3596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDI MEBERG
Title or Position: OWNER OFFICER
Credential: DPM
Phone: 321-253-3595