Provider Demographics
NPI:1669716478
Name:CHWASTIAK, ANNA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANNA MARIE
Middle Name:
Last Name:CHWASTIAK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27650 SE HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784
Mailing Address - Country:US
Mailing Address - Phone:410-241-3320
Mailing Address - Fax:352-669-6925
Practice Address - Street 1:3651 LAKE CENTER DR.
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757
Practice Address - Country:US
Practice Address - Phone:352-385-9156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPO 3582213ES0131X
PASC-004063-L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery