MEDICARE: ALF PODIATRY CARE, 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	213EP1101X	Primary Podiatric Medicine Podiatrist	PO2583	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO 2583	OTHER	FL	PODIATRY LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639460033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALF PODIATRY CARE, LLC

Provider Business Mailing Address
First Line	:	631 SW 23RD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-1929
Country	:	US
Telephone Number	:	305-854-2222
Fax Number	:	305-854-8581

Provider Business Practice Location Address
First Line	:	631 SW 23RD RD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33129-1929
Country	:	US
Telephone Number	:	305-854-2222
Fax Number	:	305-854-8581

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICIA M ROSAS-GUYON
Credential	:	DPM
Telephone Number	:	305-854-2222

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	12/15/2011

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