MEDICARE: SMITA MALHOTRA DPM

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	PO3096	FL
2	213ES0131X	Foot Surgery Podiatrist	PO3096	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

General Provider Information

NPI Number	:	1174511018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SMITA MALHOTRA DPM

Provider Business Mailing Address
First Line	:	PO BOX 551380
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32255-1380
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:	904-285-7442

Provider Business Practice Location Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:	STE 100
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:	904-285-7442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	11/16/2015

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