Provider Demographics
NPI:1932612033
Name:BH PODIATRY CARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:BH PODIATRY CARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:786-975-2090
Mailing Address - Street 1:9933 LAWLER AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-3701
Mailing Address - Country:US
Mailing Address - Phone:773-321-2681
Mailing Address - Fax:847-674-2113
Practice Address - Street 1:7025 BERACASA WAY STE 102G
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3428
Practice Address - Country:US
Practice Address - Phone:786-975-2090
Practice Address - Fax:561-755-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-10
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty