Provider Demographics
NPI:1598972614
Name:AVENTURA PODIATRY ASSOCIATES PA
Entity Type:Organization
Organization Name:AVENTURA PODIATRY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-684-4395
Mailing Address - Street 1:2925 AVENTURA BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3124
Mailing Address - Country:US
Mailing Address - Phone:305-466-2778
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-466-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2540213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6402OtherFL BLUE CROSS
FLK6402Medicare ID - Type Unspecified