MEDICARE: RANDI MARGOLIS, DPM, PA

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	PO3282	FL

General Provider Information

NPI Number	:	1669726105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDI MARGOLIS, DPM, PA

Provider Business Mailing Address
First Line	:	14545J MILITARY TRAIL, SUITE 199
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-3781
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	:	PRESIDENT
Name	:	RANDI MARGOLIS
Credential	:	D.P.M.
Telephone Number	:	561-666-7757

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	03/18/2013

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