Provider Demographics
NPI:1316512544
Name:TREASURE COAST MOBILE PODIATRY LLC
Entity type:Organization
Organization Name:TREASURE COAST MOBILE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDHIR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-586-8313
Mailing Address - Street 1:180 NW 3RD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-4118
Mailing Address - Country:US
Mailing Address - Phone:561-586-8313
Mailing Address - Fax:
Practice Address - Street 1:180 NW 3RD AVE STE A
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4118
Practice Address - Country:US
Practice Address - Phone:561-586-8313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty