Provider Demographics
NPI:1972612927
Name:MEBERG & COHEN LC
Entity Type:Organization
Organization Name:MEBERG & COHEN LC
Other - Org Name:SUNTREE-VIERA FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-253-3595
Mailing Address - Street 1:7730 N WICKHAM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-253-3595
Mailing Address - Fax:321-253-3596
Practice Address - Street 1:7730 N WICKHAM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-253-3595
Practice Address - Fax:321-253-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74947OtherBCBS ID
FLK6686Medicare PIN