Luis    Eiber    DPM
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004939
NPI
1609927631
Tax ID
592491406
Effective Date
4/1/2012
Last Updated
10/1/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
80.00
Location Details
Address
4410 West 16th Avenue Suite 53
Hialeah, FL 33012
United States
County
Miami-Dade
Phone
3055587437 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Podiatry
Map
Address