Provider Demographics
NPI:1710363692
Name:FIALKOFF, ELLIOT (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:FIALKOFF
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 1:3381 N 41ST CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1940
Mailing Address - Country:US
Mailing Address - Phone:818-317-4127
Mailing Address - Fax:
Practice Address - Street 1:3381 N 41ST CT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1940
Practice Address - Country:US
Practice Address - Phone:818-317-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR450213EP0504X, 213EP1101X, 213ES0103X
FLPO3970213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPR450OtherPODIATRIC RESIDENT REGISTRATION