Provider Demographics
NPI:1912971979
Name:WOOCIKER, SAMUEL S (DPM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:S
Last Name:WOOCIKER
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 1:445 WARRIOR TRL
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2456
Mailing Address - Country:US
Mailing Address - Phone:407-376-0522
Mailing Address - Fax:407-386-3077
Practice Address - Street 1:2014 S ORANGE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3069
Practice Address - Country:US
Practice Address - Phone:407-423-1234
Practice Address - Fax:407-517-1040
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1323213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041065900Medicaid
FLP00099490OtherR/R MEDICARE
FL87738YMedicare PIN
FL041065900Medicaid