Provider Demographics
NPI:1790761088
Name:TREVISANI, PATRICK J (DPM)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:TREVISANI
Suffix:
Gender:
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 650
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0650
Mailing Address - Country:US
Mailing Address - Phone:407-699-6706
Mailing Address - Fax:407-699-6706
Practice Address - Street 1:3532 MERIVALE DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6023
Practice Address - Country:US
Practice Address - Phone:407-699-6706
Practice Address - Fax:407-699-6706
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004176213E00000X
FLPO1844213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029647300Medicaid
FL87947Medicare PIN