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General NPI Number Information
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NPI Number | 1316512544
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Entity Type | Organization
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Legal Business Name | TREASURE COAST MOBILE PODIATRY LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 06/08/2021
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Provider Practice Location Address
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Address Line | 180 NW 3RD AVE STE A
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City | OKEECHOBEE
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State | FL
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Zip | 34972-4118
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Country | US
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Telephone | 561-586-8313
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Fax |
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Provider Business Mailing Address
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Address Line | 180 NW 3RD AVE STE A
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City | OKEECHOBEE
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State | FL
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Zip | 34972-4118
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Country | US
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Telephone | 561-586-8313
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. RANDHIR A. LAL
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Credential | DPM
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Telephone | 561-586-8313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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