Provider Demographics
NPI:1003879305
Name:PRATTS, EDWIN (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:PRATTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18221 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029
Mailing Address - Country:US
Mailing Address - Phone:954-559-1245
Mailing Address - Fax:954-437-0979
Practice Address - Street 1:2455 W FLAGLER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1439
Practice Address - Country:US
Practice Address - Phone:954-559-1245
Practice Address - Fax:305-501-4059
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2175213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058273500Medicaid
FL058273500Medicaid
FLU27931Medicare UPIN