Healthcare Provider Details

I. General information

NPI: 1164420766
Provider Name (Legal Business Name): MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 SW 72ND AVE STE 107
MIAMI FL
33155-5524
US

IV. Provider business mailing address

4990 SW 72ND AVE STE 107
MIAMI FL
33155-5524
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-1299
  • Fax: 954-772-1495
Mailing address:
  • Phone: 954-772-1299
  • Fax: 954-772-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateFL

VIII. Authorized Official

Name: SILVIO A MARTINEZ
Title or Position: PRESIDENT
Credential: CPO/LPO
Phone: 954-772-1299