Provider Demographics
NPI:1225154370
Name:DIPIERRO, DOMINIC EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:EDWARD
Last Name:DIPIERRO
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 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:2250 OSPREY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4340
Practice Address - Country:US
Practice Address - Phone:863-680-7214
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001057A213ES0103X
OH36003446213ES0103X
FLPO3821213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000572072OtherANTHEM
OH2791019Medicaid
INP00818709OtherRAILROAD MEDICARE
INP00718155OtherRAILROAD MEDICARE
0698420009Medicare NSC
OH4209855Medicare PIN
INP00718155OtherRAILROAD MEDICARE
0698420015Medicare NSC
IN192770A7Medicare PIN
0698420002Medicare NSC
INP00818709OtherRAILROAD MEDICARE
OH2791019Medicaid