Provider Demographics
NPI:1942200241
Name:WINE, HARVEY I (DPM)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:I
Last Name:WINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 409
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0526
Mailing Address - Country:US
Mailing Address - Phone:972-712-7773
Mailing Address - Fax:972-712-3134
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 409
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0526
Practice Address - Country:US
Practice Address - Phone:972-596-1331
Practice Address - Fax:972-867-5485
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0412213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T16692Medicare UPIN