Provider Demographics
NPI:1326022641
Name:CHARARA, HUSNI A (DPM)
Entity Type:Individual
Prefix:
First Name:HUSNI
Middle Name:A
Last Name:CHARARA
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 1:8851 BOARDROOM CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4888
Mailing Address - Country:US
Mailing Address - Phone:239-481-7000
Mailing Address - Fax:239-481-8150
Practice Address - Street 1:8851 BOARDROOM CIRCLE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4888
Practice Address - Country:US
Practice Address - Phone:239-481-7000
Practice Address - Fax:239-481-8150
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0656080001OtherMEDICARE DME
FL480009395OtherRAILROAD MEDICARE
FL65119YMedicare PIN
FL480009395OtherRAILROAD MEDICARE
FL65119ZMedicare PIN
FL65119ZMedicare PIN