Provider Demographics
NPI:1700203742
Name:SAIMA ISMAILI DPM
Entity Type:Organization
Organization Name:SAIMA ISMAILI DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAILI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-571-0602
Mailing Address - Street 1:1012 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5719
Mailing Address - Country:US
Mailing Address - Phone:843-571-0602
Mailing Address - Fax:843-571-0605
Practice Address - Street 1:1012 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5719
Practice Address - Country:US
Practice Address - Phone:843-571-0602
Practice Address - Fax:843-571-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6719350002Medicare NSC