MEDICARE: PRABHAKAR PODIATRY LLC

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	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1093545824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRABHAKAR PODIATRY LLC

Provider Business Mailing Address
First Line	:	6020 NW 38TH ST
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-7007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 NW 38TH ST
Second Line	:
City	:	VIRGINIA GARDENS
State	:	FL
Zip	:	33166-7007
Country	:	US
Telephone Number	:	786-300-8840
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RAJ PRABHAKAR
Credential	:	DPM
Telephone Number	:	786-300-8840

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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