Provider Demographics
NPI:1023113024
Name:POLIZZI ADVANCE FOOT CARE PA
Entity type:Organization
Organization Name:POLIZZI ADVANCE FOOT CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:863-422-2356
Mailing Address - Street 1:208 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3404
Mailing Address - Country:US
Mailing Address - Phone:863-422-2356
Mailing Address - Fax:863-421-0087
Practice Address - Street 1:208 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3404
Practice Address - Country:US
Practice Address - Phone:863-422-2356
Practice Address - Fax:863-421-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74868OtherBLUE CROSS BLUE SHIELD
FLK0610AMedicare PIN
FL0995330001Medicare NSC