Provider Demographics
NPI:1386643286
Name:NATIONAL PODIATRIC NETWORK INC
Entity Type:Organization
Organization Name:NATIONAL PODIATRIC NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-221-6862
Mailing Address - Street 1:9831 NW 58TH ST
Mailing Address - Street 2:SUITE # 127
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2713
Mailing Address - Country:US
Mailing Address - Phone:305-221-6862
Mailing Address - Fax:305-221-2033
Practice Address - Street 1:9831 NW 58TH ST
Practice Address - Street 2:SUITE # 127
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2713
Practice Address - Country:US
Practice Address - Phone:305-221-6862
Practice Address - Fax:305-221-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2910,PO2282,PO2971213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340104900Medicaid
FLK1738Medicare ID - Type Unspecified