Basic Information
| Provider Information | |||||||||
| NPI: | 1447509542 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAIMA ISMAILI DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 PHYSICIANS DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435710602 | ||||||||
| FaxNumber: | 8435710605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1012 PHYSICIANS DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435710602 | ||||||||
| FaxNumber: | 8435710605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2012 | ||||||||
| LastUpdateDate: | 03/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | ISMAILI | ||||||||
| AuthorizedOfficialFirstName: | SAIMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8435710602 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | SC | N | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213ES0103X | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.