Provider Demographics
NPI:1548461148
Name:PRIMARY FOOT CARE CENTER, INC.
Entity type:Organization
Organization Name:PRIMARY FOOT CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-948-8497
Mailing Address - Street 1:1100 NE 163RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4515
Mailing Address - Country:US
Mailing Address - Phone:305-948-8497
Mailing Address - Fax:
Practice Address - Street 1:1100 NE 163RD ST STE 101
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4515
Practice Address - Country:US
Practice Address - Phone:305-948-8497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2352213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390144100Medicaid
FL390144100Medicaid
FLU46867Medicare UPIN