Provider Demographics
NPI:1871779322
Name:GLENN C. BERKIN,DPM
Entity type:Organization
Organization Name:GLENN C. BERKIN,DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:BERKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-751-1531
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:103
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:305-751-1531
Mailing Address - Fax:305-932-9963
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:103
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-751-1531
Practice Address - Fax:305-932-9963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1561213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1318280001Medicare NSC