Provider Demographics
NPI:1790977171
Name:MESSINA, CARLO ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARLO
Middle Name:ANTHONY
Last Name:MESSINA
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 1:1600 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:954-349-2441
Mailing Address - Fax:954-349-7161
Practice Address - Street 1:1839 N 78TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3638
Practice Address - Country:US
Practice Address - Phone:847-933-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.000613213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery