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General NPI Number Information
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NPI Number | 1073774634
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Entity Type | Organization
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Legal Business Name | MOHANAD A ELTAHIR DPM PA
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 3800 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7793
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Country | US
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Telephone | 305-681-2600
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Fax | 305-685-0906
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Provider Business Mailing Address
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Address Line | 3800 W 12TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7793
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Country | US
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Telephone | 305-681-2600
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Fax | 305-685-0906
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Authorized Official
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Title or Position | OWNER
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Name | MOHANAD A ELTAHIR
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Credential | DPM
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Telephone | 305-682-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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