Provider Demographics
NPI:1902167810
Name:VYACHESLAV MAKAROV DPM PA
Entity Type:Organization
Organization Name:VYACHESLAV MAKAROV DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKAROV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-324-0919
Mailing Address - Street 1:230 174TH ST
Mailing Address - Street 2:2214
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3332
Mailing Address - Country:US
Mailing Address - Phone:917-324-0919
Mailing Address - Fax:305-354-7111
Practice Address - Street 1:1400 NE MIAMI GARDENS DR STE 105
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4843
Practice Address - Country:US
Practice Address - Phone:305-974-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3522213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3983Medicare PIN