Provider Demographics
NPI:1689602237
Name:GLODOWSKI, MITCHELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:GLODOWSKI
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 1:3901 LAS POSAS RD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1501
Mailing Address - Country:US
Mailing Address - Phone:805-531-1089
Mailing Address - Fax:808-531-5489
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE #9
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-531-1089
Practice Address - Fax:808-531-5489
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4616213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4616Medicare PIN
CAE4614AMedicare PIN
CAE4616BMedicare PIN