Healthcare Provider Details

I. General information

NPI: 1063900348
Provider Name (Legal Business Name): TREASURE COAST MEDICAL PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 MISTY MORN RD
PALM BEACH GARDENS FL
33418
US

IV. Provider business mailing address

5216 MISTY MORN RD
PALM BEACH GARDENS FL
33418-7824
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: PHYSICIAN
Credential: DPM
Phone: 561-586-8313