Provider Demographics
NPI:1437302601
Name:NORTH PORT PODIATRY CENTER PA
Entity Type:Organization
Organization Name:NORTH PORT PODIATRY CENTER PA
Other - Org Name:NORTH PORT & ENGLEWOOD PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-429-1702
Mailing Address - Street 1:14580 TAMIAMI TRL UNIT H
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2708
Mailing Address - Country:US
Mailing Address - Phone:941-429-1702
Mailing Address - Fax:941-429-0981
Practice Address - Street 1:14580 TAMIAMI TRL UNIT H
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2708
Practice Address - Country:US
Practice Address - Phone:941-429-1702
Practice Address - Fax:941-429-0981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3256213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU8683YMedicare PIN
FLU8683Medicare PIN
FLV06159Medicare UPIN