PREMIUM PODIATRY HEALTHCARE & SERVICES INC. NPI 1831574557

NPI Information

NPI: 1831574557
Provider Name: PREMIUM PODIATRY HEALTHCARE & SERVICES, INC.
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
1611 NW 12TH AVE
MIAMI, FL
ZIP 33136
Phone: (305) 710-1971
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PREMIUM PODIATRY HEALTHCARE & SERVICES, INC. is a podiatrist in Miami, FL. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. PREMIUM PODIATRY HEALTHCARE & SERVICES, INC. NPI is 1831574557. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1611 NW 12TH AVE
MIAMI, FL
ZIP 33136-005
Phone: (305) 710-1971

The provider's authorized official is Lisa M Detournay .
The authorized official title is Owner/podiatrist and has the following contact phone number (305) 710-1971.

The enumeration date for this NPI number is 7/23/2015 and was last updated on 8/12/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213E00000X	Podiatrist		E5133	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	029750000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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