Provider Demographics
NPI:1619132594
Name:MEDICAL ARTS FOOT CARE CENTER PA
Entity Type:Organization
Organization Name:MEDICAL ARTS FOOT CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-752-1999
Mailing Address - Street 1:8100 ROYAL PALM BLVD
Mailing Address - Street 2:112
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5733
Mailing Address - Country:US
Mailing Address - Phone:954-752-1999
Mailing Address - Fax:954-752-8756
Practice Address - Street 1:8100 ROYAL PALM BLVD
Practice Address - Street 2:112
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5733
Practice Address - Country:US
Practice Address - Phone:954-752-1999
Practice Address - Fax:954-752-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041207401Medicaid
FL6079340001Medicare NSC