Provider Demographics
NPI:1003864042
Name:EMELIANCHIK, ANTHONY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:EMELIANCHIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 PREVATT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6141
Mailing Address - Country:US
Mailing Address - Phone:352-589-4601
Mailing Address - Fax:
Practice Address - Street 1:2051 PREVATT ST
Practice Address - Street 2:SUITE B
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6141
Practice Address - Country:US
Practice Address - Phone:352-589-4601
Practice Address - Fax:352-589-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2285213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65257YMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL