Healthcare Provider Details

I. General information

NPI: 1316512544
Provider Name (Legal Business Name): TREASURE COAST MOBILE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NW 3RD AVE STE A
OKEECHOBEE FL
34972-4118
US

IV. Provider business mailing address

180 NW 3RD AVE STE A
OKEECHOBEE FL
34972-4118
US

V. Phone/Fax

Practice location:
  • Phone: 561-586-8313
  • Fax:
Mailing address:
  • Phone: 561-586-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RANDHIR A. LAL
Title or Position: MEMBER
Credential: DPM
Phone: 561-586-8313