| Lidet Real Corporation | |
|
1611 Nw 12th Ave, Miami, FL 33136-1005 | |
| (305) 710-1971 | |
| Not Available |
| Full Name | Lidet Real Corporation |
|---|---|
| Type | Facility |
| Speciality | Podiatrist |
| Location | 1611 Nw 12th Ave, Miami, Florida |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518361385 | NPI | - | NPPES |
| 029750000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | 5133 (California) | Primary |
| Provider Name | Lisa M Detournay |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1952301426 PECOS PAC ID: 2860662038 Enrollment ID: I20120430000479 |
| Mailing Address | Practice Location Address |
|---|---|
| Lidet Real Corporation 1235 Mariposa Ave Apt 2, Coral Gables, FL 33146-3252 Ph: (305) 710-1971 | Lidet Real Corporation 1611 Nw 12th Ave, Miami, FL 33136-1005 Ph: (305) 710-1971 |
Podiatry Network Solutions Of Louisiana, Llc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 7220 Nw 36th St, Suite 103, Miami, FL 33166 Phone: 786-924-0044 Fax: 305-667-8860 | |
All Feet Podiatry Inc. Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 8390 W Flagler St, Ste 110, Miami, FL 33144 Phone: 305-480-5522 Fax: 305-480-5422 | |
Dr. Edwin Pratts, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 2455 W Flagler St, Suite 1, Miami, FL 33135 Phone: 954-559-1245 Fax: 305-501-4059 | |
Shama Pervaiz, Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1611 Nw 12th Ave, Miami, FL 33136 Phone: 305-585-1111 | |
Dr. Tyler Bowers, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 2500 Sw 7th Ave, Miami, FL 33129 Phone: 305-264-5252 | |
Dr. Elroy Albert Kalme Lopez, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1227 Sw 3rd Ave Apt 504, Miami, FL 33130 Phone: 786-531-6800 | |
Mr. Michael R Cook, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 8955 Sw 87th Court, Ste 108, Miami, FL 33176 Phone: 305-412-1218 Fax: 305-412-4151 |