Provider Demographics
NPI:1518141654
Name:CHARLES A SULESKEY DPM PA
Entity Type:Organization
Organization Name:CHARLES A SULESKEY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:941-493-7999
Mailing Address - Street 1:1832 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3127
Mailing Address - Country:US
Mailing Address - Phone:941-493-7999
Mailing Address - Fax:941-493-6852
Practice Address - Street 1:1832 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3127
Practice Address - Country:US
Practice Address - Phone:941-493-7999
Practice Address - Fax:941-493-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1729213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480029500OtherRR MEDICARE
FL87901OtherBC BS FL
FL152463529OtherCHAMPUS
FL87901Medicare PIN
FL1021460001Medicare NSC
FLEU750AMedicare PIN
FL152463529OtherCHAMPUS