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NPI Code Detail

MEDICARE: DR. NICHOLAS JOSEPH CORETTI III DPM

MEDICARE: DR. NICHOLAS JOSEPH CORETTI III DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristPO3838FL

General Provider Information

NPI Number : 1235500422
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS JOSEPH CORETTI III DPM
Provider Business Mailing Address
First Line : 15773 NW 3RD ST
Second Line :
City : PEMBROKE PINES
State : FL
Zip : 33028-1588
Country : US
Telephone Number : 305-712-6395
Fax Number : 305-630-8590
Provider Business Practice Location Address
First Line : 2951 NW 49TH AVE STE 201
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33313-1608
Country : US
Telephone Number : 954-486-5700
Fax Number : 954-484-2574
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2015
Last Update Date : 06/20/2022

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