Provider Demographics
NPI:1538823349
Name:SUNRISE PODIATRY LLC
Entity type:Organization
Organization Name:SUNRISE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-742-7003
Mailing Address - Street 1:7800 WEST OAKLAND PARK BLVD
Mailing Address - Street 2:BLDG C, STE 108
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-1121
Mailing Address - Country:US
Mailing Address - Phone:954-742-7003
Mailing Address - Fax:954-742-7012
Practice Address - Street 1:7800 WEST OAKLAND PARK BLVD
Practice Address - Street 2:BLDG C, STE 108
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-1121
Practice Address - Country:US
Practice Address - Phone:954-742-7003
Practice Address - Fax:954-742-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO4299OtherMEDICAL LICENSE