Healthcare Provider Details

I. General information

NPI: 1568851897
Provider Name (Legal Business Name): MIAMI FOOT AND ANKLE SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12605 NE 7TH AVE
NORTH MIAMI FL
33161-4813
US

IV. Provider business mailing address

12605 NE 7TH AVE
NORTH MIAMI FL
33161-4813
US

V. Phone/Fax

Practice location:
  • Phone: 305-893-9883
  • Fax:
Mailing address:
  • Phone: 305-893-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3692
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID AUGUSTE
Title or Position: OWNER
Credential: DPM
Phone: 786-877-4929