Provider Demographics
NPI:1154332021
Name:STANIMIROV, CATHERINE (DPM)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:STANIMIROV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N MACDILL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5152
Mailing Address - Country:US
Mailing Address - Phone:917-930-0497
Mailing Address - Fax:
Practice Address - Street 1:2123 W DR MARTIN LUTHER KING JR BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6545
Practice Address - Country:US
Practice Address - Phone:813-999-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005558-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049838Medicaid
NY02049838Medicaid
NYU79861Medicare UPIN