Provider Demographics
NPI:1164633368
Name:DIABETIC SOLES, INC
Entity type:Organization
Organization Name:DIABETIC SOLES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-919-9128
Mailing Address - Street 1:13910 LYNMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3123
Mailing Address - Country:US
Mailing Address - Phone:678-919-9128
Mailing Address - Fax:888-495-8205
Practice Address - Street 1:2959 CHEROKEE ST NW STE 103D
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6522
Practice Address - Country:US
Practice Address - Phone:789-199-1286
Practice Address - Fax:888-495-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5105760001Medicare ID - Type Unspecified