MEDICARE: KARINA D BAESSO DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3466	FL

General Provider Information

NPI Number	:	1780981035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA D BAESSO DPM

Provider Business Mailing Address
First Line	:	5103 SW 141ST AVE
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5968
Country	:	US
Telephone Number	:	954-907-2191
Fax Number	:	305-829-5324

Provider Business Practice Location Address
First Line	:	3661 S MIAMI AVE STE 309
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4232
Country	:	US
Telephone Number	:	305-854-6600
Fax Number	:	305-854-6602

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

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/15/2012

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