Provider Demographics
NPI:1659368892
Name:DZIKOWSKI, COLLEEN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:M
Last Name:DZIKOWSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 COLONIAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5674
Mailing Address - Country:US
Mailing Address - Phone:954-297-8267
Mailing Address - Fax:954-337-0849
Practice Address - Street 1:5800 COLONIAL DR STE 203
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5674
Practice Address - Country:US
Practice Address - Phone:954-297-8267
Practice Address - Fax:954-337-0849
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2529213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390285400Medicaid
FL65455Medicare ID - Type Unspecified
FL390285400Medicaid