Provider Demographics
NPI:1245202225
Name:CHICO, GEOVANNY (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEOVANNY
Middle Name:
Last Name:CHICO
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 1:5767 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2939
Mailing Address - Country:US
Mailing Address - Phone:407-737-1518
Mailing Address - Fax:407-737-1198
Practice Address - Street 1:5767 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2939
Practice Address - Country:US
Practice Address - Phone:407-737-1518
Practice Address - Fax:407-737-1198
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0002585213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U63931Medicare UPIN
FL65470AMedicare ID - Type Unspecified
FL1313750001Medicare NSC