Provider Demographics
NPI:1790761088
Name:TREVISANI, PATRICK J (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:TREVISANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0650
Mailing Address - Country:US
Mailing Address - Phone:407-331-3470
Mailing Address - Fax:407-331-5084
Practice Address - Street 1:500 S R 436
Practice Address - Street 2:SUITE 2092
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6023
Practice Address - Country:US
Practice Address - Phone:407-331-3470
Practice Address - Fax:407-331-5084
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO1844213E00000X
NYN004176213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55615Medicare UPIN
FL87947Medicare PIN