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General NPI Number Information
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NPI Number | 1295551257
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Entity Type | Organization
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Legal Business Name | PODIRA LLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 2500 E HALLANDALE BEACH BLVD STE 811
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4841
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Country | US
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Telephone | 224-616-1952
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Fax |
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Provider Business Mailing Address
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Address Line | 2625 10TH AVE SE
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City | NAPLES
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State | FL
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Zip | 34117-4598
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Country | US
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Telephone | 224-616-1952
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IRAKLY PATARAIA
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Credential | DPM
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Telephone | 224-616-1952
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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 |
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License Number State |
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