Healthcare Provider Details

I. General information

NPI: 1548461148
Provider Name (Legal Business Name): PRIMARY FOOT CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NE 163RD ST STE 101
NORTH MIAMI BEACH FL
33162-4515
US

IV. Provider business mailing address

1100 NE 163RD ST STE 101
NORTH MIAMI BEACH FL
33162-4515
US

V. Phone/Fax

Practice location:
  • Phone: 305-948-8497
  • Fax:
Mailing address:
  • Phone: 305-948-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2352
License Number StateFL

VIII. Authorized Official

Name: DR. TAMARA DAWN FISHMAN
Title or Position: OWNER
Credential: DPM
Phone: 305-948-8497