Provider Demographics
NPI:1003852450
Name:KURECKI, SCOTT PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:PAUL
Last Name:KURECKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:P
Other - Last Name:KURECKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PA
Mailing Address - Street 1:12757 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1934
Mailing Address - Country:US
Mailing Address - Phone:941-426-1167
Mailing Address - Fax:941-426-2571
Practice Address - Street 1:12757 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1934
Practice Address - Country:US
Practice Address - Phone:941-426-1167
Practice Address - Fax:941-426-2571
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001946213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN7786OtherMEDICARE EDI SENDER NUMBR
FL029759300Medicaid
FL480007561OtherRAILROAD MEDICARE
FL65088OtherBC/BS OF FLORIDA
FL65088OtherBC/BS OF FLORIDA
FL029759300Medicaid
FL65088ZMedicare PIN