Provider Demographics
NPI:1720017866
Name:CENTRAL FLORIDA PODIATRY, INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PODIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:KATARZYNA
Authorized Official - Last Name:BARTOSZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:727-572-5449
Mailing Address - Street 1:12180 28TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1820
Mailing Address - Country:US
Mailing Address - Phone:727-572-5449
Mailing Address - Fax:727-573-2048
Practice Address - Street 1:724 CHARLES ST.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808
Practice Address - Country:US
Practice Address - Phone:407-209-7175
Practice Address - Fax:407-523-9325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3097213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340504400Medicaid
FL340504400Medicaid
FLK9521Medicare PIN
FLDE6015Medicare PIN
FL5699270001Medicare NSC