Healthcare Provider Details

I. General information

NPI: 1538823349
Provider Name (Legal Business Name): SUNRISE PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 WEST OAKLAND PARK BLVD BLDG C, STE 108
SUNRISE FL
33351-1121
US

IV. Provider business mailing address

7800 WEST OAKLAND PARK BLVD BLDG C, STE 108
SUNRISE FL
33351-1121
US

V. Phone/Fax

Practice location:
  • Phone: 954-742-7003
  • Fax: 954-742-7012
Mailing address:
  • Phone: 954-742-7003
  • Fax: 954-742-7012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HARVEY L KATZ
Title or Position: PODIATRIST
Credential: DPM
Phone: 954-742-7003