Provider Demographics
NPI:1730703851
Name:MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC
Entity type:Organization
Organization Name:MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SILVIO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO
Authorized Official - Phone:786-360-5514
Mailing Address - Street 1:4990 SW 72ND AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5524
Mailing Address - Country:US
Mailing Address - Phone:786-360-5514
Mailing Address - Fax:786-536-5693
Practice Address - Street 1:4208 N 31ST AVE STE 2
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2002
Practice Address - Country:US
Practice Address - Phone:786-360-5514
Practice Address - Fax:786-536-5693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAHNKE'S ORTHOTICS & PROSTHETICS OF DEERFIELD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-04
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022580600Medicaid