Provider Demographics
NPI:1740288356
Name:ROUKIS, THOMAS SEAN (DPM, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SEAN
Last Name:ROUKIS
Suffix:
Gender:M
Credentials:DPM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16021 CITRUS KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9473
Mailing Address - Country:US
Mailing Address - Phone:608-738-9900
Mailing Address - Fax:
Practice Address - Street 1:265 E ROLLINS ST STE 11100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5570
Practice Address - Country:US
Practice Address - Phone:844-407-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4225213ES0103X, 213E00000X
WAPO00000811213E00000X
WI779213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004963Medicaid
IL60000380OtherBCBS
U72812Medicare UPIN
ILL83872Medicare ID - Type Unspecified