MEDICARE: MARINA PODIATRY ASSOCIATES 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	E1141	CA

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	:	1548306590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINA PODIATRY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	2477 CHESTNUT STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2505
Country	:	US
Telephone Number	:	415-921-1922
Fax Number	:	415-921-0771

Provider Business Practice Location Address
First Line	:	2477 CHESTNUT STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-2505
Country	:	US
Telephone Number	:	415-921-1922
Fax Number	:	415-921-0771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD H MICHAEL
Credential	:	DPM
Telephone Number	:	415-921-1922

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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