Provider Demographics
NPI:1871893057
Name:MIAMI PODIATRY LLC
Entity type:Organization
Organization Name:MIAMI PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-227-0062
Mailing Address - Street 1:3959 S NOVA RD
Mailing Address - Street 2:BUILDING B SUITE 25
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9278
Mailing Address - Country:US
Mailing Address - Phone:786-277-8612
Mailing Address - Fax:386-236-9006
Practice Address - Street 1:3959 S NOVA RD
Practice Address - Street 2:BUILDING B SUITE 25
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9278
Practice Address - Country:US
Practice Address - Phone:786-277-8612
Practice Address - Fax:386-236-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEC751AMedicare PIN