Provider Demographics
NPI:1013042167
Name:GALLINATTI, JON B (DPM)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:B
Last Name:GALLINATTI
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 1:7620 NW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:305-829-5001
Mailing Address - Fax:305-829-3902
Practice Address - Street 1:7620 NW 186TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-829-5001
Practice Address - Fax:305-829-3902
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2101213E00000X, 213EP1101X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390038000Medicaid
FL65204OtherBCBS
FL65204Medicare PIN
FLU22786Medicare UPIN