| Premium Podiatry Healthcare & Services, Inc. | |
|
1611 Nw 12th Ave, Miami, FL 33136-1005 | |
| (305) 710-1971 | |
| Not Available |
| Full Name | Premium Podiatry Healthcare & Services, Inc. |
|---|---|
| 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 |
|---|---|---|---|
| 1831574557 | NPI | - | NPPES |
| 029750000 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | E5133 (California) | Primary |
| Provider Name | Lisa M Detournay |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1952301426 PECOS PAC ID: 2860662038 Enrollment ID: I20140718000630 |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Podiatry Healthcare & Services, Inc. 1235 Mariposa Ave Apt 2, Coral Gables, FL 33146-3252 Ph: (305) 710-1971 | Premium Podiatry Healthcare & Services, Inc. 1611 Nw 12th Ave, Miami, FL 33136-1005 Ph: (305) 710-1971 |
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