Provider Demographics
NPI:1275950511
Name:MACHADO, KATHERINE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 NW 27TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1902
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:8785 SW 165TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193
Practice Address - Country:US
Practice Address - Phone:305-385-9494
Practice Address - Fax:305-385-1145
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3588213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010895600Medicaid