Provider Demographics
NPI:1891166773
Name:COLLEEN DZIKOWSKI DPM LLC
Entity Type:Organization
Organization Name:COLLEEN DZIKOWSKI DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-684-5716
Mailing Address - Street 1:5800 COLONIAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5674
Mailing Address - Country:US
Mailing Address - Phone:954-297-8267
Mailing Address - Fax:954-337-0849
Practice Address - Street 1:5800 COLONIAL DR STE 203
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5674
Practice Address - Country:US
Practice Address - Phone:954-297-8267
Practice Address - Fax:954-337-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-17
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02529213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty