Provider Demographics
NPI:1346325115
Name:NORTH, SANDY CRAIG (DPM)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:CRAIG
Last Name:NORTH
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 1:18623 S DIXIE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-238-9111
Mailing Address - Fax:305-256-6130
Practice Address - Street 1:18623 S DIXIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-238-9111
Practice Address - Fax:305-256-6130
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02262213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U22809Medicare UPIN
65315Medicare ID - Type Unspecified