Provider Demographics
NPI:1073610069
Name:HORN, MERRICK L (DPM)
Entity Type:Individual
Prefix:DR
First Name:MERRICK
Middle Name:L
Last Name:HORN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:909 NORTH MIAMI BEACH BLVD
Mailing Address - Street 2:SUITE #401
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3712
Mailing Address - Country:US
Mailing Address - Phone:305-949-4189
Mailing Address - Fax:305-949-4010
Practice Address - Street 1:909 NORTH MIAMI BEACH BLVD
Practice Address - Street 2:SUITE #401
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3712
Practice Address - Country:US
Practice Address - Phone:305-949-4189
Practice Address - Fax:305-949-4010
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP00001987213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053750100Medicaid
FL65084Medicare PIN
T87851Medicare UPIN
FL4865450001Medicare NSC