Provider Demographics
NPI:1700812260
Name:MARIN FOOT & ANKLE CENTER PA
Entity type:Organization
Organization Name:MARIN FOOT & ANKLE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-826-7774
Mailing Address - Street 1:13825 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5303
Mailing Address - Country:US
Mailing Address - Phone:305-826-7774
Mailing Address - Fax:305-826-5505
Practice Address - Street 1:3410 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4906
Practice Address - Country:US
Practice Address - Phone:305-826-7774
Practice Address - Fax:305-826-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390286201Medicaid
FLAA219Medicare PIN
FL4165430001Medicare NSC
FLU64310Medicare UPIN