MEDICARE: TOTAL FOOT CARE CLINIC 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

General Provider Information

NPI Number	:	1821265984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL FOOT CARE CLINIC INC

Provider Business Mailing Address
First Line	:	3300 W 84TH ST
Second Line	:	BAY #16
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:	305-818-7070
Fax Number	:	305-818-7080

Provider Business Practice Location Address
First Line	:	3300 W 84TH ST
Second Line	:	BAY #16
City	:	HIALEAH
State	:	FL
Zip	:	33018-4903
Country	:	US
Telephone Number	:	305-818-7070
Fax Number	:	305-818-7080

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICARDO REYES
Credential	:	DPM
Telephone Number	:	305-818-7070

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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