Provider Demographics
NPI:1841255700
Name:SURPRENANT, MARIA SUE (DPM)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SUE
Last Name:SURPRENANT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-662-1444
Mailing Address - Fax:305-667-6086
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-662-1444
Practice Address - Fax:305-667-6086
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2515213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65460Medicare PIN
FLF09686Medicare UPIN