Healthcare Provider Details

I. General information

NPI: 1164649117
Provider Name (Legal Business Name): MICHAEL A GARVIN DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NW BETHANY DR
PORT SAINT LUCIE FL
34986-3578
US

IV. Provider business mailing address

1791 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952
US

V. Phone/Fax

Practice location:
  • Phone: 772-871-6020
  • Fax:
Mailing address:
  • Phone: 772-335-7171
  • Fax: 772-335-2119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1984
License Number StateFL

VIII. Authorized Official

Name: MRS. MADDY VALDES
Title or Position: BILLING MANAGER
Credential:
Phone: 772-335-7171