Provider Demographics
NPI:1477896215
Name:MARTINCEVIC, MATTHEW JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:MARTINCEVIC
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 1:2400 N ORANGE BLOSSOM TRL STE 305
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-2308
Mailing Address - Country:US
Mailing Address - Phone:407-657-9188
Mailing Address - Fax:407-677-4770
Practice Address - Street 1:2400 N ORANGE BLOSSOM TRL STE 305
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2308
Practice Address - Country:US
Practice Address - Phone:407-657-9188
Practice Address - Fax:407-677-4770
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3871213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program