Provider Demographics
NPI:1326154832
Name:BUSTAMANTE, EDWARD A (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:BUSTAMANTE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1906
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:9220 SUNSET DR STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3259
Practice Address - Country:US
Practice Address - Phone:305-596-9999
Practice Address - Fax:305-398-5067
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2750213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340094800Medicaid
FLT6659Medicare UPIN
FL340094800Medicaid
FL5884870002Medicare NSC