Provider Demographics
NPI:1558361097
Name:BARTOSZEK, AGNES KATARZYNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:KATARZYNA
Last Name:BARTOSZEK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:AGNES
Other - Middle Name:KATARZYNA
Other - Last Name:BARTOSZEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:724 CHARLES ST.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-209-7175
Mailing Address - Fax:407-366-1931
Practice Address - Street 1:12180 28TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1820
Practice Address - Country:US
Practice Address - Phone:727-572-5449
Practice Address - Fax:727-573-2048
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3097213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340504400Medicaid
FL340504400Medicaid
FL5699270001Medicare NSC
FLU1872WMedicare PIN
FLP000303264Medicare PIN
FLU97980Medicare UPIN