Active NPI
Premium Podiatry Healthcare & Services, Inc.
- Podiatrist
- Miami, FL
National Provider Identifier
1831574557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- E5133
- Legal business name
- PREMIUM PODIATRY HEALTHCARE & SERVICES, INC.
- Practice address
- 1611 NW 12TH Ave
Miami, FL 33136-1005 - Phone
- (305) 710-1971
- NPI assigned
- Jul 23, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Lisa M Detournay, DPM
- Title
- Owner/Podiatrist
- Phone
- (305) 710-1971
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | E5133 | CA | Primary |
Addresses
Primary practice location
1611 NW 12TH Ave
Miami, FL 33136-1005
Mailing address
1235 Mariposa Ave Apt 2
Coral Gables, FL 33146-3252
Phone (305) 710-1971
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 029750000 | Medicaid | FL |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437609600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1597190400000",
"number": "1831574557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 MARIPOSA AVE APT 2",
"city": "CORAL GABLES",
"state": "FL",
"postal_code": "331463252",
"telephone_number": "305-710-1971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1611 NW 12TH AVE",
"city": "MIAMI",
"state": "FL",
"postal_code": "331361005",
"telephone_number": "305-710-1971"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIUM PODIATRY HEALTHCARE & SERVICES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2015-07-23",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A",
"authorized_official_last_name": "DETOURNAY",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "OWNER/PODIATRIST",
"authorized_official_telephone_number": "305-710-1971",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DPM"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist",
"state": "CA",
"license": "E5133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "029750000",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.