Provider Demographics
NPI:1669726105
Name:RANDI MARGOLIS, DPM, PA
Entity type:Organization
Organization Name:RANDI MARGOLIS, DPM, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-666-7757
Mailing Address - Street 1:14545J MILITARY TRAIL, SUITE 199
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-3781
Mailing Address - Country:US
Mailing Address - Phone:561-666-7757
Mailing Address - Fax:561-496-6739
Practice Address - Street 1:3770 RIVERSIDE WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-1284
Practice Address - Country:US
Practice Address - Phone:561-666-7757
Practice Address - Fax:561-496-6739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty