Provider Demographics
NPI:1861660623
Name:ISMAILI, SAIMA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAIMA
Middle Name:
Last Name:ISMAILI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 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
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC587213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC01730281Medicare PIN