Healthcare Provider Details

I. General information

NPI: 1942200241
Provider Name (Legal Business Name): HARVEY I WINE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 COIT RD SUITE 409
FRISCO TX
75035-0526
US

IV. Provider business mailing address

4461 COIT RD SUITE 409
FRISCO TX
75035-0526
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-1331
  • Fax: 972-867-5485
Mailing address:
  • Phone: 972-712-7773
  • Fax: 972-712-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0412
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: