Healthcare Provider Details

I. General information

NPI: 1003879305
Provider Name (Legal Business Name): EDWIN PRATTS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 W FLAGLER ST SUITE 1
MIAMI FL
33135-1439
US

IV. Provider business mailing address

18221 SW 22ND ST
MIRAMAR FL
33029
US

V. Phone/Fax

Practice location:
  • Phone: 954-559-1245
  • Fax: 305-501-4059
Mailing address:
  • Phone: 954-559-1245
  • Fax: 954-437-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: