Provider Demographics
NPI:1891127304
Name:ZIEMER, MEGAN MATASSINI (DPM)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MATASSINI
Last Name:ZIEMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3665
Mailing Address - Country:US
Mailing Address - Phone:813-495-6473
Mailing Address - Fax:
Practice Address - Street 1:950 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3665
Practice Address - Country:US
Practice Address - Phone:863-295-5604
Practice Address - Fax:863-295-5398
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3761213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3761OtherPODIATRY LICENSE