# MARISEL MEDINA DPM PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588768733
- **Authorized official:** MARISEL MEDINA (PRESIDENT)
- **Authorized official phone:** (786) 317-8037

## Contact information

- **Practice address:** 11760 SW 40TH ST, STE H 451, MIAMI, FL 33175
- **Practice address phone:** (786) 317-8033
- **Mailing address:** 11930 N BAYSHORE DR, APT 310, N MIAMI, FL 33181
- **Mailing address phone:** (786) 317-8033
- **Mailing address fax:** (305) 891-7324

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | P03198 | FL | Yes |

## Other

- **Enumeration date:** 09/09/2006
- **Last updated:** 09/25/2007