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1164420766 NPI number — MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC

NPI Number: 1164420766
Health Care Provider/Practitioner: MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC

Information about “1164420766” NPI (MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC) exists in 1164420766 in HTML format HTML  |  1164420766 in plain Text format TXT  |  1164420766 in PDF (Portable Document Format) PDF  |  1164420766 in an XML format XML  formats.

NPI Number : 1164420766 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164420766",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4990 SW 72ND AVE",
    "SecondLineMailingAddress": "STE 107",
    "MailingAddressCityName": "MIAMI",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33155-5524",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-772-1299",
    "MailingAddressFaxNumber": "954-772-1495",
    "FirstLinePracticeLocationAddress": "4990 SW 72ND AVE",
    "SecondLinePracticeLocationAddress": "STE 107",
    "PracticeLocationAddressCityName": "MIAMI",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33155-5524",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-772-1299",
    "PracticeLocationAddressFaxNumber": "954-772-1495",
    "EnumerationDate": "07/08/2005",
    "LastUpdateDate": "04/30/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MARTINEZ",
    "AuthorizedOfficialFirstName": "SILVIO",
    "AuthorizedOfficialMiddleName": "A",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CPO/LPO",
    "AuthorizedOfficialTelephoneNumber": "954-772-1299",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "335E00000X",
        "TaxonomyName": "Prosthetic/Orthotic Supplier",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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