Individual
DR. MAIKHOI T PHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM, MBA
Contact information
Practice address
538 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34984-5108
(772) 871-5900
(772) 871-1197
Mailing address
538 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34984-5108
(772) 871-5900
(772) 871-1197
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
2029
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
PO3506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
318118201
—
TX
05
—
318118202
—
TX
05
—
9426400
—
FL
01
—
P01144991
MEDICARE TRA
TX
Enumeration date
10/25/2011
Last updated
11/13/2020
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