Provider Demographics
NPI:1982693206
Name:BUSILLO, FRANK STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:STEVEN
Last Name:BUSILLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 221493
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33022-1493
Mailing Address - Country:US
Mailing Address - Phone:954-989-1786
Mailing Address - Fax:954-989-3895
Practice Address - Street 1:6888 TAFT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5657
Practice Address - Country:US
Practice Address - Phone:954-989-1786
Practice Address - Fax:954-989-3895
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3103213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340602400Medicaid
FLQ0562Medicare PIN
FL340602400Medicaid
FL5854690001Medicare NSC