Provider Demographics
NPI:1306848767
Name:FISHMAN, TAMARA (DPM)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FISHMAN
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 1:1100 NE 163RD ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4515
Mailing Address - Country:US
Mailing Address - Phone:305-948-8497
Mailing Address - Fax:
Practice Address - Street 1:1100 NE 163RD ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4515
Practice Address - Country:US
Practice Address - Phone:305-948-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2352213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390144100Medicaid
FL65317Medicare ID - Type Unspecified
FLU46867Medicare UPIN