MEDICARE: MICHAEL DEROUIN DPM,FACFAS

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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO-000950	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	:	1356430888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DEROUIN DPM,FACFAS

Provider Business Mailing Address
First Line	:	2780 N ROOSEVELT BLVD STE 2
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-3930
Country	:	US
Telephone Number	:	305-294-5553
Fax Number	:	305-294-6670

Provider Business Practice Location Address
First Line	:	2780 N ROOSEVELT BLVD STE 2
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-3930
Country	:	US
Telephone Number	:	305-294-5553
Fax Number	:	305-294-6670

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/16/2023

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