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Individual
NITIE I SROA
Active
Individual
NITIE I SROA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
07001153A
IN
213E00000X
Podiatrist
07001153B
IN
213E00000X
Podiatrist
Primary
PO3700
FL
213E00000X
Podiatrist
POD001257
GA
213ES0131X
Foot Surgery Podiatrist
POD001257
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07001153A
PODIATRIC LICENSE
IN
01
—
07001153B
PODIATRIC LICENSE
IN
01
—
36.003857
PODIATRIC LICENSE
OH
01
—
PO3700
PODIATRIC FLORIDA LICENSE
FL
01
—
POD001257
PODIATRY LICENSE
GA
Enumeration date
03/22/2011
Last updated
05/06/2021
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