MEDICARE: BRIAN PAVLAS 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	PO3232	FL

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	:	1982823175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN PAVLAS DPM PA

Provider Business Mailing Address
First Line	:	4821 SW 64TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6105
Country	:	US
Telephone Number	:	305-968-0644
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 SW 64TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-6105
Country	:	US
Telephone Number	:	305-968-0644
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN PAVLAS
Credential	:	DPM
Telephone Number	:	305-968-0644

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	12/01/2009

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