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General NPI Number Information
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NPI Number | 1871893057
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Entity Type | Organization
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Legal Business Name | MIAMI PODIATRY LLC
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 3959 S NOVA RD BUILDING B SUITE 25
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City | PORT ORANGE
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State | FL
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Zip | 32127-9278
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Country | US
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Telephone | 786-277-8612
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Fax | 386-236-9006
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Provider Business Mailing Address
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Address Line | 3959 S NOVA RD BUILDING B SUITE 25
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City | PORT ORANGE
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State | FL
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Zip | 32127-9278
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Country | US
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Telephone | 786-277-8612
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Fax | 386-236-9006
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Authorized Official
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Title or Position | MCC
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Name | LAURA B BURKE
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Credential |
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Telephone | 786-227-0062
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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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