Provider Demographics
NPI:1003032509
Name:ALL FLORIDA PODIATRY PA
Entity Type:Organization
Organization Name:ALL FLORIDA PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:G
Authorized Official - Last Name:COLALUCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-384-1111
Mailing Address - Street 1:PO BOX 13165
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-3165
Mailing Address - Country:US
Mailing Address - Phone:727-384-1111
Mailing Address - Fax:727-384-1112
Practice Address - Street 1:5760 10TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-6432
Practice Address - Country:US
Practice Address - Phone:727-384-1111
Practice Address - Fax:727-384-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2815213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL649524OtherTUFTS
FL111877OtherAMERIGROUP
FL2700633OtherUNITED HEALTHCARE
FL65644OtherBLUE CROSS BLUE SHIELD
FL163508OtherSTAYWELL
FL21212024000OtherBEECHSTREET
FL11010101OtherCITRUS CAID
FL1734395OtherFIRST HEALTH
FL163508OtherSTAYWELL
FL649524OtherTUFTS
FL65644OtherBLUE CROSS BLUE SHIELD
FL=========OtherUNIVERSAL HEALTHCARE
FL2700633OtherUNITED HEALTHCARE