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General NPI Number Information
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NPI Number | 1033168281
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Entity Type | Organization
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Legal Business Name | HEATH FOOT AND LEG CLINIC LLC
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Dates
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Enumeration Date | 05/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2525 EMBASSY DR SUITE 4
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City | COOPER CITY
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State | FL
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Zip | 33026-4573
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Country | US
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Telephone | 954-243-8176
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Fax |
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Provider Business Mailing Address
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Address Line | 8135 NW 198TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33015-6390
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Country | US
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Telephone | 305-816-0073
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID JOHN HEATH
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Credential | D.P.M.
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Telephone | 954-243-8176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3203
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License Number State | FL
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