Healthcare Provider Details

I. General information

NPI: 1861634065
Provider Name (Legal Business Name): SANDRA R. GOTMAN, D.P.M., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 07/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST SUITE 616
MIAMI FL
33175-8100
US

IV. Provider business mailing address

11760 SW 40TH ST SUITE 616
MIAMI FL
33175-8100
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-9595
  • Fax: 305-229-9596
Mailing address:
  • Phone: 305-229-9595
  • Fax: 305-229-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 1678
License Number StateFL

VIII. Authorized Official

Name: SANDRA R GOTMAN
Title or Position: PRESIDENT/ DOCTOR
Credential: D.P.M.
Phone: 305-229-9596