Provider Demographics
NPI:1457548364
Name:PRZYSTAWSKI, NICHOLAS (DPM)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PRZYSTAWSKI
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:PO BOX 491334
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-1334
Mailing Address - Country:US
Mailing Address - Phone:352-360-1360
Mailing Address - Fax:352-360-0686
Practice Address - Street 1:913 E NORTH BLVD
Practice Address - Street 2:STE B
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5364
Practice Address - Country:US
Practice Address - Phone:352-360-1360
Practice Address - Fax:352-360-0686
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002004213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65384OtherBLUE CROSS/BLUE SHIELD
FLT21497Medicare UPIN
FL65384AMedicare PIN