Provider Demographics
NPI:1396767497
Name:LAY FREMD, CARMEN B (DPM)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:B
Last Name:LAY FREMD
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 1:17971 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:305-933-2666
Mailing Address - Fax:305-933-3508
Practice Address - Street 1:17971 BISCAYNE BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160
Practice Address - Country:US
Practice Address - Phone:305-933-2666
Practice Address - Fax:305-933-3508
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2339213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390089400Medicaid
FL390089400Medicaid
FL65279Medicare ID - Type Unspecified