MEDICARE: NORTH GABLES FOOT CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	PO2666	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063577476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH GABLES FOOT CLINIC INC

Provider Business Mailing Address
First Line	:	4540 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2307
Country	:	US
Telephone Number	:	305-461-3448
Fax Number	:

Provider Business Practice Location Address
First Line	:	4540 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2307
Country	:	US
Telephone Number	:	305-461-3448
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	RICARDO REYES
Credential	:
Telephone Number	:	305-461-3448

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	10/28/2021

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