Provider Demographics
NPI:1902867120
Name:BLEAU, CURTIS MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:MICHAEL
Last Name:BLEAU
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 1:3117 SPRING GLEN RD
Mailing Address - Street 2:STE 402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5906
Mailing Address - Country:US
Mailing Address - Phone:904-224-2001
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:1824 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1904
Practice Address - Country:US
Practice Address - Phone:904-387-0740
Practice Address - Fax:904-387-9799
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001753213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480025470OtherRAILROAD
FLCI4974OtherPALMETTO GBA RAILROAD MCARE
65047UMedicare PIN
21698HMedicare PIN
FL480025470OtherRAILROAD
FLCI4974OtherPALMETTO GBA RAILROAD MCARE
21698IMedicare PIN
65047TMedicare PIN