Provider Demographics
NPI:1548446354
Name:PALM SANDS PODIATRY PLLC
Entity type:Organization
Organization Name:PALM SANDS PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GABE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-400-0931
Mailing Address - Street 1:1001 N FEDERAL HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2416
Mailing Address - Country:US
Mailing Address - Phone:954-454-5221
Mailing Address - Fax:954-458-4232
Practice Address - Street 1:1001 N FEDERAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2416
Practice Address - Country:US
Practice Address - Phone:954-454-5221
Practice Address - Fax:954-458-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1674213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0342740001Medicare NSC
ILP00362517OtherRAILROAD MEDICARE
ILT38518Medicare UPIN
IL751441Medicare PIN
IL60001520OtherBLUE CROSS BLUE SHIELD