Provider Demographics
NPI:1427166594
Name:MIRAMAR PODIATRY AND SURGERY INSTITUTE LLC
Entity type:Organization
Organization Name:MIRAMAR PODIATRY AND SURGERY INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIS-CALIXTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-442-6100
Mailing Address - Street 1:8910 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4100
Mailing Address - Country:US
Mailing Address - Phone:954-442-6100
Mailing Address - Fax:954-442-6202
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:SUITE 117
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:954-442-6100
Practice Address - Fax:954-442-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3243213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340589300Medicaid
FL5747630001Medicare NSC
FLQ0125Medicare PIN