MEDICARE: DR. RANDI D MARGOLIS D.P.M.

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	E3857	CA
2	213ES0131X	Foot Surgery Podiatrist	E3857	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AH184A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1376548636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDI D MARGOLIS D.P.M.

Provider Business Mailing Address
First Line	:	3770 RIVERSIDE WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-1284
Country	:	US
Telephone Number	:	561-666-7757
Fax Number	:	561-496-6739

Provider Business Practice Location Address
First Line	:	3770 RIVERSIDE WAY
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-1284
Country	:	US
Telephone Number	:	561-666-7757
Fax Number	:	561-496-6739

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	02/04/2013

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