Provider Demographics
NPI:1134116379
Name:MARIN, LUIS E (DPM)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:E
Last Name:MARIN
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 1:3410 W 84TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4906
Mailing Address - Country:US
Mailing Address - Phone:305-826-7774
Mailing Address - Fax:305-826-5505
Practice Address - Street 1:3410 W 84TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4906
Practice Address - Country:US
Practice Address - Phone:305-826-7774
Practice Address - Fax:305-826-5505
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2510213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390286200Medicaid
FL390286200Medicaid
FLU64310Medicare UPIN